Curriculum vitae et studiorum

Rossi Stefano nato a Roma il 18051964

Diploma di Qualifica di Odontotecnico conseguito nellas 198182 presso lIstituto Professionale di Stato di via Aquilonia 30 in Roma con la votazione di 75100

Diploma di Maturitagrave di Odontotecnico conseguito nellas 198283 presso il medesimo Istituto con la votazione di 6060

Laurea in Odontoiatria e Protesi Dentaria conseguita presso lUniversitagrave degli Studi di Roma La Sapienza con la votazione di 110110 e Lode

Tesi di Laurea sperimentale pubblicata dal titolo ldquoStudio sperimentale comparativo clinico-radiologico per il trasferimento e montaggio dei modelli in articolatorerdquo

Abilitato allesercizio professionale presso lo stesso Ateneo con la votazione di 6060

Iscritto allAlbo Professionale degli Odontoiatri presso lOrdine dei Medici Chirurghi e degli Odontoiatri di Roma

con numero di iscrizione 4044

Master Internazionale Biennale di secondo livello in

Implantologia Orale e Riabilitazioni Protesiche

Direttore Prof Manlio Quaranta

Tesi finale pubblicata dal titolo

ldquoCarico precoce dalla sperimentazione alla clinicardquo

conseguito presso le Universitagrave degli studi di

Roma 1 ldquoLa Sapienza

Roma 2 Tor Vergata

ldquoG DAnnunzio di Chietirdquo

ldquoFaculdade de Medicina de Coimbra Departamento de Medicina Dentagraveria Estomatologia e Cirurgia Maxilo-Facialrdquo

Coimbra (Portugal)

Il 200605 consegue Borsa di Studio biennale presso LrsquoIstituto di Clinica Odontoiatrica dellrsquoUniversitagrave degli Studi di Roma ldquoLa Sapienzardquo per lo svolgimento di ldquoIndagine clinica sullrsquouso degli impianti TMIreg in Implantoprotesirdquo

Nellrsquo Anno Accademico 200607 egrave vincitore del concorso per il Dottorato di Ricerca in Malattie Odontostomatologiche XXII ciclo e svolge funzioni di Dottorando di Ricerca presso il Dipto di Scienze Odontostomatologiche Ideg Facoltagrave di Medicina e Chirurgia dellrsquo Universitagrave degli Studi di Roma ldquoSapienzardquo

Il 060409 consegue una seconda borsa di studio triennale presso il Dipto di Scienze Odontostomatologiche dellrsquoUniversitagrave degli Studi di Roma ldquoLa Sapienzardquo per lo svolgimento di una ricerca sullrsquouso degli impianti TMIreg con il protocollo clinico del carico immediato

Incaricato dallrsquo Anno Accademico 200304 dellrsquoinsegnamento di ldquoTecnologie Protesiche e di Laboratoriordquo (Titolare Prof Giorgio Pompa) presso il Corso di Laurea Specialistico in Odontoiatria e Protesi Dentaria dellrsquo Universitagrave degli Studi di Roma Sapienza

Docente del Master di II livello in ldquoImplantoprotesi in Odontostomatologiardquo

Direttore Prof Manlio Quaranta

presso

il Dipto di Scienze Odontostomatologiche dellrsquo Universitagrave di Roma ldquoSapienzardquo

Il 04 03 2010 consegue il titolo di Dottore di Ricerca in Malattie Odontostomatologiche presso il Dipartimanto di Scienze Odontostomatologiche della Ideg Facoltagrave di Medicina e Chirurgia dellrsquoUniversitagrave degli Studi di Roma ldquoSapienzardquo con una tesi dal titolo

ldquo VALUTAZIONE SPERIMENTALE CLINICO RADIOLOGICA SULLrsquoUSO DEGLI IMPIANTI A RIPARAZIONE OSSEA PRIMARIA NEL CARICO

IMMEDIATO POST ESTRATTIVOrdquo

Il 28052010 riceve il titolo di

Professore a contratto

per lrsquoinsegnamento di

ldquoImplantoprotesi in Odontostomatologiardquo

al Master di II livello presso il Dipto di Scienze Odontostomatologiche della Ideg

Facoltagrave di Medicina e Chirurgia Universitagrave di Roma ldquoSapienzardquo

Autore di numerose pubblicazioni in campo scientifico nazionale e internazionale

87th General Session amp Exhibition of the IADRMiami Florida - April 1-4 2009

CLINICAL EVALUATION OF OSSEOINTEGRATION OF IMPLANTS PLACED IN GRAFTED BONEI VOZZA S ROSSI L PICCOLI and M QUARANTA

Dental School Prosthodontics Department ldquoLa Sapienzardquo University Rome Italy

INTRODUCTION

Primary Bone Regeneration (PBR) is a mechanism of natural bone healing leading to consolidation of two bone segments in 6 weeks In Implant-Prosthodontics

PBR implants let the patient have quicker prosthetic rehabilitation also in case of severe bone atrophy and after guided bone regeneration In fact with PBR implantsitrsquos possible to load them just after 45 days from implants insertion This depends on primary intention bone healing with direct formation of bone tissue close incontact with implants and without interposition of connective tissue The aim of this study was to evaluate osseointegration in early loaded PBR implants insertedtogether with bone grafts in atrophic alveolar ridges

REFERENCES

Cornelini R Barone A Covani U Connective tissue grafts in postextraction implants with immediate restoration a prospective controlled clinical study Pract Proced Aesthet Dent 2008 Jul20(6)337-43

Esposito M Grusovin MG Achille H Coulthard P Worthington HV Interventions for replacing missing teeth different times for loading dental implants Cochrane Database Syst Rev 2009 Jan 21(1)CD003878

Friberg B Raghoebar GM et al A 5-year prospective multicenter study on 1-stage smooth-surface Branemark System implants with early loading in edentulous mandibles Int J Oral Maxillofac Implants 2008 May23(3)481-6

Lai HC Zhang ZY Zhuang LF Wang F Liu X Pu YP Early loading of ITI implants supporting maxillary fixed full-arch prostheses Clin Oral Implants Res 2008 Nov19(11)1129-34

Malchiodi L Quaranta A Scarano A Quaranta M Jaw reconstruction with grafted autologous bone early insertion of osseointegrated implants and early prosthetic loading J Oral Maxillofac Surg 2006 Aug64(8)1190-8

Mannai C Early implant loading in severely resorbed maxilla using xenograft autograft and platelet-rich plasma in 97 patients J Oral Maxillofac Surg 2006 Sep64(9)1420-6

Piattelli A Corigliano M Scarano A Quaranta M Bone reactions to early occlusal loading of two-stage titanium plasma-sprayed implants a pilot study in monkeys Int J Periodontics Restorative Dent 1997 Apr17(2)162-9

Sennerby L Gottlow J Clinical outcome of immediatelyearly loading of dental implants A literature review of recent controlled prospective clinical studies Aust Dent J 2008 Jun53 Suppl 1S82-8

MATERIALS AND METHODSIn our Prosthodontics Dept Sapienza University of Rome from November 2004 to October 2007 we selected 24 patients (both sexes 42 years mean age wellhealthy no smokers) having maxillary and mandibular partial atrophic alveolar ridges and asking for implant supported prostheses We inserted 78 rot ormer PBRimplants (TMIreg Pressing Dental San Marino Italy) together with a bone graft material (BioOss Geistlich) Minimum implant diameter was 375mm and minimumlength was 105mm The primary implant stability was estimated by RFA When the ISQ resulted ge 57 value in the 2nd stage surgery they were early loaded (15months from surgery) The ISQ values were subsequently estimated every month until the 6th month then at 9 and 12 months The endoral X-rays have beenexecuted to 0 2 6 9 and 12 months

RESULTSIn the 2nd stage surgery a complete bone defect filling was observed in all the cases except one that was characterized by partial bone defect filling (greater than50 and without flap dehiscence) The most significant ISQ values increase was observed in the first 2 months a further ISQ value increasing was observed until the3rd-4th month and successively the ISQ values levelled on constant shares At the end of the second month just 6 implants (77) of 5 different patients didnrsquot show57 ISQ value Among these implants 2 showed clinical mobility (M) in early time (third and fourth month) and they were removed and indicated like failures Theendoral X-ray didnrsquot show any change of the marginal bone level Clinical and X-ray results analized with T-Student test were statistically significant (Plt0005)

CONCLUSIONSThe timing of bone tissue healing around TMI implants overlap timing of a simple fracture of the jaw bones These results showed as early loading of PBR implants

inserted together bone grafts seems to be a valid technique to restore atrophic alveolar ridges shortening healing time and having quicker clinical case resolution

689

87th General Session amp Exhibition of the IADRMiami Florida - April 1-4 2009

CLINICAL AND HISTOLOGICAL EVALUATION OF ATROPHIC MAXILLARY RIDGES IMPLANT REHABILITATIONI VOZZA S ROSSI AM CARPIO E NICOLINI and G POMPA

Dental School Prosthodontics Department ldquoLa Sapienzardquo University Rome Italy

INTRODUCTION

The latest and new indications about implant surgery and the constant introduction on the market of new components and methodologies go hand in handwith the ever-increasing demand from our patients for a quicker and quicker functional rehabilitation Primary Bone Regeneration (PBR) is a mechanism ofnatural bone healing leading to consolidation of two bone segments in 6 weeks In Implant-Prosthodontics PBR implants let the patient have quickerprosthetic rehabilitation also in case of severe bone atrophy and after guided bone regeneration In fact with PBR implants itrsquos possible to load them justafter 45 days from implants insertion This depends on primary intention bone healing with direct formation of bone tissue close in contact with implants andwithout interposition of connective tissue The aim of this study was to evaluate early loading of PBR (Primary Bone Regeneration) implants insertedtogether with bone grafts in atrophic maxillary ridges

REFERENCES

Attard NJ Zarb GA Immediate and early implant loading protocols a review of clinical studies J Prosthet Dent 2005 Sep 94 (3) 242-58

Brochu JF Anderson JD Zarb GA The influence of early loading on bony crest height and stability a pilot study Int J Prosthodont 2005 Nov-Dec 18 (6) 506-12

Cornelini R Barone A Covani U Connective tissue grafts in postextraction implants with immediate restoration a prospective controlled clinical study Pract Proced Aesthet Dent 2008 Jul20(6)337-43

Esposito M Grusovin MG Achille H Coulthard P Worthington HV Interventions for replacing missing teeth different times for loading dental implants Cochrane Database Syst Rev 2009 Jan 21(1)CD003878

Friberg B Raghoebar GM A 5-year prospective multicenter study on 1-stage smooth-surface Branemark System implants with early loading in edentulous mandibles Int J Oral Maxillofac Implants 2008 May-Jun23(3)481-6

Malchiodi L Quaranta A Scarano A Quaranta M Jaw reconstruction with grafted autologous bone early insertion of osseointegrated implants and early prosthetic loading J Oral Maxillofac Surg 2006 Aug64(8)1190-8

Mannai C Early implant loading in severely resorbed maxilla using xenograft autograft and platelet-rich plasma in 97 patients J Oral Maxillofac Surg 2006 Sep64(9)1420-6

Lai HC Zhang ZY Zhuang LF Wang F Liu X Pu YP Early loading of ITI implants supporting maxillary fixed full-arch prostheses Clin Oral Implants Res 2008 Nov19(11)1129-34

Piattelli A Corigliano M Scarano A Quaranta M Bone reactions to early occlusal loading of two-stage titanium plasma-sprayed implants a pilot study in monkeys Int J Periodontics Restorative Dent 1997 Apr17(2)162-9

Sennerby L Gottlow J Clinical outcome of immediatelyearly loading of dental implants A literature review of recent controlled prospective clinical studies Aust Dent J 2008 Jun53 Suppl 1S82-8

MATERIALS AND METHODSIn our Prosthodontics Dept Sapienza University of Rome from November 2004 to June 2007 a sinus lifting was performed in 8 patients (56 years mean agemale gender initial bone height of 15 -2 mm and bone width of 5 mm) asking for a fixed implant-supported rehabilitation They signed an informed consentIn every patient 2root former PBR implants (TMIreg Pressing Dental San Marino Italy) having 325 diameter and 105mm length were inserted together witha bone graft material (Physiograftreg Ghimas) 25 months after maxillary sinus augmentation one of the implants was retrieved and processed forundecalcified histology while the other one was loaded The endoral X-rays have been executed to 0 2 6 9 and 12 months

RESULTSFrom the histomorphometric analysis the graft material residuals accounted for the 4698 of the bioptical volume marrow spaces for the 1876 and bonefor the 3287 (new bone 2262 native bone 1025) Well-mineralized regenerated bone with lamellar parallel-fibred structure and Haversian systemssurrounded the residual graft material particles The measured BIC amounted to 1694 No connective tissue was observed at the implant boundary surfaceFrom clinical point of view there was no implant failure at the 2nd stage neither mobility nor bleeding on probing The endoral X-rays showed a completebone defect filling and no change of the marginal bone level was observed Clinical and X-ray results analized with T-Student test were statistically significant

(Plt0005) CONCLUSIONSThese results showed as early loading of PBR implants inserted together with bone grafts appears to be suitable for maxillary sinus floor augmentation alsoin critical condition as minimal vertical bone height and shorter healing time

3389

Objectives The aim of this study was to obtain immediate bone reparation in only 6 wks and to predict primary bone apposition

without intermediate growth of the connective tissue

Methods We inserted 128 PBR (Primary Bone Reparation) implants (TMIreg Pressing Dental RSM) into 42 patients of both

genders aged between 29 and 68 yrs After 45 days 25 implants were removed from their sites carefully chosen so as not

to endanger either the final prosthesis plan or the patients health The removed samples were embedded in resin (Tecnovit

Kulzer) histologically prepared (EXAKT) and stained with hematoxylin eosin and methylene blue The same samples

were then examined histologically under an optical microscope (Zeiss and Leitz) at 50-100-200-400X

86th General Session and Exibition of the IADR ndash Metro Toronto Convention Centre Canada

Histologic evaluation of a PBR implant system study in manM CORIGLIANO1 S ROSSI2 AM CARPIO2 and S DI CARLO2

1International Academy of Implantoprosthesis and Osteoconnection Rome Italy 2University

of Rome Sapienza Italy

1 Schenk RK Histologie der Primarien Knocheilung Verh Dtsch ges pathol 1974 54 8-12

2 Corigliano M Vrespa G DrsquoAddona A Casolo F Impianto a guarigione primaria Dental Cadmos 1994 11 60-72

3 Piattelli A Paolantonio M Corigliano M Scarano A Immediate loading of titanium plasma-sprayed screw-shaped implants in man a clinical and histological report of two cases J Periodontol 199768591-

597

3 Corigliano M Barlattani A Gargari M Ottria L Andreana S La riparazione ossea primaria in implantoprotesi possibilitagrave tecnica ed applicazioni Quint Int 2002 910 359-370

4 Cooper LF Rahman A Moriarty J Chaffee N Sacco D Immediate mandibular rehabilitation with endosseous implants simultaneous extraction implant placement and loadingInt J Oral Maxillofac

Implants 200217(4)517-25

5 Gherlone E Albano F Vrespa G Falegatti G Capuano A Carico immediato su impianti post estrattivi immediati Implantologia 2004125-37

6 Forabosco A et al Impianti postestrattivi a carico immediato Doctor Os 200617(1)188-190

6

TMI reg Implant System is composed by

Fig1 Pilot Drill

Fig2 Osteotom ldquo UNICArdquo

Fig3 Implant

2

Results The quantity and the quality of the bone observed histologically

in connection with the radicular titanium prostheses following PBR

registered complete growth The BIC (Bone Implant Contact) measured

all around the removed implants averaged 85 Further there were no

necrotic zones associated with the resorption or substitution with

connective fibrous tissue

Conclusions Our histologic analysis demonstrates that the PBR

implant system is without doubt reliable Actually it permits a

great deal of bone to support the progressive load of dental

prostheses

2

Histological images coloured

with hematoxylineosin and

methilene blue

Surgycal phases

1 Drilling

2 Osteotomy with ldquoUNICArdquo

3 Radicular prostheses

insert

85th General Session amp Exhibition of the IADRNew Orleans 21-24 March 2007

EARLY LOADED IMPLANT SUPPORTED OVERDENTURE 3-YEAR FOLLOW-UP EVALUATIONS ROSSI I VOZZA A GIOVANNETTI MP BASILE S DI CARLO

Dental School Prosthodontics Department ldquoLa Sapienzardquo University Rome Italy

INTRODUCTION

Primary Bone Reparation PBR is a mechanism of natural bone healing determining consolidation of two bone segments in 6 weeks In Implantology PBR implantsconsent to patient having prosthetic rehabilitation briefly because it is possible to load them just in 45 days form fixture insertion This is possible thanking to firstintention bone healing with direct formation of bone tissue in contact with implant and without interposition of connective tissue Times of tissue reparationaround implants are superimposable to times of a simple fracture of maxilla The aim of this study was to evaluate perimplant marginal bone level on early loadedimplants supporting overdenture

REFERENCES

Attard NJ Zarb GA Immediate and early implant loading protocols a literature review of clinical studies J Prosthet Dent 200594(3)242-58

Brochu JF Anderson JD Zarb GA The influence of early loading on bony crest height and stability a pilot study Int J Prosthodont 200518(6)506-12

Chiapasco M Early and immediate restoration and loading of implants in completely edentulous patients Int J Oral Maxillofac Implants 200419 Suppl76-91

Mericske-Stern R Oetterli M Kiener P Mericske E A follow-up study of maxillary implants supporting an overdenture clinical and radiographic results Int J Oral Maxillofac Implants 200217(5)678-86

Misch CE Degidi M 5-year prospective study of immediateearly loading of fixed prostheses in completely edentulous jaw with a bone quality-based implant system Clin Implant Dent Relat Res 20035(1)17-28

Payne AG Tawse-Smith A Thomson WM Duncan WD Kumara R One-stage surgery and early loading of three implants for maxillary overdenture a 1-year report Clin Implant Dent Relat Res 20046(2)61-74

Raghoebar GM Friberg B Grunert I Hobkirk JA Tepper G Wendelhag I 3-year prospective multicenter study on one-stage implant surgery and early loading in the edentulous mandible Clin Implant Dent Relat Res 20035(1)39-46

Raghoebar GM Schoen P Meijer HJ Stellingsma K Vissink A Early loading of endosseous implants in the augmented maxilla a 1-year prospective study Clin Oral Implants Res 200314(6)697-702

MATERIALS AND METHODSIn our Prosthodontics Depratment La Sapienza University of Rome from May 2001 to December November 2003 we selected 30 patients (both sexes 49 yearsmean age no smokers) having maxillary total edentulism and asking for fixed prosthetic rehabilitation We inserted 128 root former implants (TMI PressingDental San Marino) they were early loaded after 45 days Minimum diameter was 42mm and minimum length was 13mm Before cementation of each finalrestoration we executed a periapical X-ray using a digital X-ray system (Den Optix Gendex Dentsply Int) The X-ray controls were executed after 1-3-6-9-12months and then yearly

RESULTSMarginal bone levels were evaluated by 2 different operators using a computerised measure system (Vix-win 2000 Gendex Dentsply Int) During the first yearthere was 028mm mean bone loss while during the next two years it was 017mm according to Albrektsson and Zarb implant success criteria (lt1mm during thefirst year and lt02mm during next years) X-ray results analized with T-Student test were statistically significant (Plt0005)

CONCLUSIONSParameters for the valuation of Implantology success have to be established before discussing about obtained results by this experimentation On the basis ofthis osseointegration definition clinical studies have to be purposed to survey the implant stability under functional loading In this order itrsquos necessary thatduring periodic controls implant mobility has to be evaluated and radiographic examinations have to be executed in a reproducible way for determining the stateof perimplant bone tissue health The implant success is evaluated on the following criteria by Albrektsson and Zarb 1) the not splinted implant has to be clinicallyimmovable 2) on the X-ray no perimplant radiotranslucency marks have to be present 3) vertical bone loss has to be lower than 1mm during the first year ofloading and lower than 02mm yearly in the following years 4) each implant has to be without marks or persistent andor not reversible symptoms for examplepain infections neuropathies paresthesis or penetration into the mandibular canal 5)prosthetic restoration has to satisfy function and aesthetics On thesepreliminary remarks in the anterior upper and lower sectors it should occur a success rate of 90 and 85 on long time respectively after 5 and 10 years in theposterior sectors these percentages have to be about 85 after 5 years and 80 after 10 years The obtained results from this experimentation are encouragingfully respecting implant success criteria by Albrektsson and Zarb These results showed as early loaded implants supporting overdenture are clinically andradiographically well osseointegrated

516

Introduction ndash It has been clearly proved by Ludwig through Fourierrsquos analysis [ Ludwig1993] that ultraweak signals are easly recognazed compared with the background noise if they present a patternthe signals the living matter is able to recognized among a variety of interferential signals are highly complex that is they are made up of different frequency bands Infact the complex signal reaches the biological system as a repetition of weak signals but connected among them in a fixed pattern and it is the

repetition of this pattern that distinguish the ldquotrue signalrdquo from the background noise The action of the CMF identifies as the sum of the effects of superimposed continous and pulsed magnetic fields on biological systemsOn the bone tissue is possible to obtain a neo-osteomorphogenesis increasing the gene expression of the morphogenetic proteins

and modulating the osteoclastogenetic proteins action The same results we can obtain on soft tissue The target of our clinical trial ldquoin vivordquo can demonstrate the effects of Combined Magnetic Field on the bone tissue in oral implantology

Methods 458 patients of both genders aged between 35 and 72 yrs underwent implant surgery associated with GBR according to the protocol of the PBR implant system 1024

fixtures were inserted by means of the TMIreg implant system (Pressing Dental RSM) The MET and CMF (MFI Italy) were applied to all patients for 74 days

Osteogenesis was radiologically controlled after 30 60 90 and 120 days All implants were loaded in 120 days

86th General Session and Exibition of the IADR ndash Metro Toronto Convention Centre Canada

Osteomorphogenesis biostimulated by CMF Combined Magnetic Fields M Corigliano1 S Rossi2 F Crescentini2 A Giovanetti2 S Di Carlo2

1International Academy of Implantoprosthesis and Osteoconnection Rome Italy 2 University of Rome Sapienza Italy

Induttori della TME

applicati

CMF-OS amp BR (1) TME (2) MFI Production

1

2

Stimulated morphogenetic proteins gene expression

and modulation of osteoclastogenesis by CMF induction

FGF-2 FGFai AngiopoietinTrombopoietin EGFConnexin 43 Cox-1 e Cox-2 BMP-2 BMP-4 c-myc e c-fosG-proteinCollagen I osteocalcin

Signal Molecules Erk frac12CREBIRS-1eNOS Cytokine IL1 TNFαTNFβTGkαTGFβPDGFIGF-1IGF-

2FGF Osteoclastogenesis Modulators OPGRank RANKL

M-CSFPGE2 EnzymesCytocrome-OssidaseNaK-ATPase hsp70

ornithine decarboxilase adinylate-cyclase protein kinase C

Densification Proteins and ions Osteocalcin Procollagenionized calcium ALPEstrogen-receptor system

Proteoglycans Collagen IIITP1 TPIII

Results All those who underwent implant therapy with GBR and were treated with the combination of MET and CMF showed complete mineralization in a shorter period of time than that commonly reported in these

cases

Conclusions The combined use of MET and CMF together with the PBR implant system can ameliorate and strengthen the physiological mechanisms of bone reparation

Materials CMF-OS ampBR Inductor of CMF multifrequential and presequential with continous magnetic fields Frequency from 1 to 80Hz Amplitude from 1

a 100μT and field amplifierconcentrator TME inductor of bifrequential fieldAmplitude from 5 a 50G for domiciliary use

Induction Method 6 inductions with CMF every 3 days for 12 mindie and TME domiciliary 30min X 2die X 45 days( inductors MFI Italy)

1 2 3

Soft Tissues unsuccessfull gengivoplasty Fase1 date 11042007 (2)date 11182007 (3)12062007 CMF treated 6 X 12 min induction sequenced every 3days

Ludwig W Magneitc Field Therapy In Alternative Medicine Future Medicine Publishing Washington (1993) McLeod BR Liboff AR Dynamic characteristics of membrane ions in multifield configurations of low-frequency

electromagnetic radiationBioelectromagnetics 19867(2)177-89

Blank M Goodman R Electromagnetic fields may act directly on DNADepartment of Physiology Columbia University New York New York 10032 USA mb32columbiaedu J Cell Biochem 1999 Dec 175(3)369-74

Fig1 Dental-Scan Fig2 Implants Fig3 RX results After 45 days

CMF-TME therapy 1 2 3

Laurea in Odontoiatria e Protesi Dentaria conseguita presso lUniversitagrave degli Studi di Roma La Sapienza con la votazione di 110110 e Lode

Tesi di Laurea sperimentale pubblicata dal titolo ldquoStudio sperimentale comparativo clinico-radiologico per il trasferimento e montaggio dei modelli in articolatorerdquo

Abilitato allesercizio professionale presso lo stesso Ateneo con la votazione di 6060

Iscritto allAlbo Professionale degli Odontoiatri presso lOrdine dei Medici Chirurghi e degli Odontoiatri di Roma

con numero di iscrizione 4044

Master Internazionale Biennale di secondo livello in

Implantologia Orale e Riabilitazioni Protesiche

Direttore Prof Manlio Quaranta

Tesi finale pubblicata dal titolo

ldquoCarico precoce dalla sperimentazione alla clinicardquo

conseguito presso le Universitagrave degli studi di

Roma 1 ldquoLa Sapienza

Roma 2 Tor Vergata

ldquoG DAnnunzio di Chietirdquo

ldquoFaculdade de Medicina de Coimbra Departamento de Medicina Dentagraveria Estomatologia e Cirurgia Maxilo-Facialrdquo

Coimbra (Portugal)

Il 200605 consegue Borsa di Studio biennale presso LrsquoIstituto di Clinica Odontoiatrica dellrsquoUniversitagrave degli Studi di Roma ldquoLa Sapienzardquo per lo svolgimento di ldquoIndagine clinica sullrsquouso degli impianti TMIreg in Implantoprotesirdquo

Nellrsquo Anno Accademico 200607 egrave vincitore del concorso per il Dottorato di Ricerca in Malattie Odontostomatologiche XXII ciclo e svolge funzioni di Dottorando di Ricerca presso il Dipto di Scienze Odontostomatologiche Ideg Facoltagrave di Medicina e Chirurgia dellrsquo Universitagrave degli Studi di Roma ldquoSapienzardquo

Il 060409 consegue una seconda borsa di studio triennale presso il Dipto di Scienze Odontostomatologiche dellrsquoUniversitagrave degli Studi di Roma ldquoLa Sapienzardquo per lo svolgimento di una ricerca sullrsquouso degli impianti TMIreg con il protocollo clinico del carico immediato

Incaricato dallrsquo Anno Accademico 200304 dellrsquoinsegnamento di ldquoTecnologie Protesiche e di Laboratoriordquo (Titolare Prof Giorgio Pompa) presso il Corso di Laurea Specialistico in Odontoiatria e Protesi Dentaria dellrsquo Universitagrave degli Studi di Roma Sapienza

Docente del Master di II livello in ldquoImplantoprotesi in Odontostomatologiardquo

Direttore Prof Manlio Quaranta

presso

il Dipto di Scienze Odontostomatologiche dellrsquo Universitagrave di Roma ldquoSapienzardquo

Il 04 03 2010 consegue il titolo di Dottore di Ricerca in Malattie Odontostomatologiche presso il Dipartimanto di Scienze Odontostomatologiche della Ideg Facoltagrave di Medicina e Chirurgia dellrsquoUniversitagrave degli Studi di Roma ldquoSapienzardquo con una tesi dal titolo

ldquo VALUTAZIONE SPERIMENTALE CLINICO RADIOLOGICA SULLrsquoUSO DEGLI IMPIANTI A RIPARAZIONE OSSEA PRIMARIA NEL CARICO

IMMEDIATO POST ESTRATTIVOrdquo

Il 28052010 riceve il titolo di

Professore a contratto

per lrsquoinsegnamento di

ldquoImplantoprotesi in Odontostomatologiardquo

al Master di II livello presso il Dipto di Scienze Odontostomatologiche della Ideg

Facoltagrave di Medicina e Chirurgia Universitagrave di Roma ldquoSapienzardquo

Autore di numerose pubblicazioni in campo scientifico nazionale e internazionale

87th General Session amp Exhibition of the IADRMiami Florida - April 1-4 2009

CLINICAL EVALUATION OF OSSEOINTEGRATION OF IMPLANTS PLACED IN GRAFTED BONEI VOZZA S ROSSI L PICCOLI and M QUARANTA

Dental School Prosthodontics Department ldquoLa Sapienzardquo University Rome Italy

INTRODUCTION

Primary Bone Regeneration (PBR) is a mechanism of natural bone healing leading to consolidation of two bone segments in 6 weeks In Implant-Prosthodontics

PBR implants let the patient have quicker prosthetic rehabilitation also in case of severe bone atrophy and after guided bone regeneration In fact with PBR implantsitrsquos possible to load them just after 45 days from implants insertion This depends on primary intention bone healing with direct formation of bone tissue close incontact with implants and without interposition of connective tissue The aim of this study was to evaluate osseointegration in early loaded PBR implants insertedtogether with bone grafts in atrophic alveolar ridges

REFERENCES

Cornelini R Barone A Covani U Connective tissue grafts in postextraction implants with immediate restoration a prospective controlled clinical study Pract Proced Aesthet Dent 2008 Jul20(6)337-43

Esposito M Grusovin MG Achille H Coulthard P Worthington HV Interventions for replacing missing teeth different times for loading dental implants Cochrane Database Syst Rev 2009 Jan 21(1)CD003878

Friberg B Raghoebar GM et al A 5-year prospective multicenter study on 1-stage smooth-surface Branemark System implants with early loading in edentulous mandibles Int J Oral Maxillofac Implants 2008 May23(3)481-6

Lai HC Zhang ZY Zhuang LF Wang F Liu X Pu YP Early loading of ITI implants supporting maxillary fixed full-arch prostheses Clin Oral Implants Res 2008 Nov19(11)1129-34

Malchiodi L Quaranta A Scarano A Quaranta M Jaw reconstruction with grafted autologous bone early insertion of osseointegrated implants and early prosthetic loading J Oral Maxillofac Surg 2006 Aug64(8)1190-8

Mannai C Early implant loading in severely resorbed maxilla using xenograft autograft and platelet-rich plasma in 97 patients J Oral Maxillofac Surg 2006 Sep64(9)1420-6

Piattelli A Corigliano M Scarano A Quaranta M Bone reactions to early occlusal loading of two-stage titanium plasma-sprayed implants a pilot study in monkeys Int J Periodontics Restorative Dent 1997 Apr17(2)162-9

Sennerby L Gottlow J Clinical outcome of immediatelyearly loading of dental implants A literature review of recent controlled prospective clinical studies Aust Dent J 2008 Jun53 Suppl 1S82-8

MATERIALS AND METHODSIn our Prosthodontics Dept Sapienza University of Rome from November 2004 to October 2007 we selected 24 patients (both sexes 42 years mean age wellhealthy no smokers) having maxillary and mandibular partial atrophic alveolar ridges and asking for implant supported prostheses We inserted 78 rot ormer PBRimplants (TMIreg Pressing Dental San Marino Italy) together with a bone graft material (BioOss Geistlich) Minimum implant diameter was 375mm and minimumlength was 105mm The primary implant stability was estimated by RFA When the ISQ resulted ge 57 value in the 2nd stage surgery they were early loaded (15months from surgery) The ISQ values were subsequently estimated every month until the 6th month then at 9 and 12 months The endoral X-rays have beenexecuted to 0 2 6 9 and 12 months

RESULTSIn the 2nd stage surgery a complete bone defect filling was observed in all the cases except one that was characterized by partial bone defect filling (greater than50 and without flap dehiscence) The most significant ISQ values increase was observed in the first 2 months a further ISQ value increasing was observed until the3rd-4th month and successively the ISQ values levelled on constant shares At the end of the second month just 6 implants (77) of 5 different patients didnrsquot show57 ISQ value Among these implants 2 showed clinical mobility (M) in early time (third and fourth month) and they were removed and indicated like failures Theendoral X-ray didnrsquot show any change of the marginal bone level Clinical and X-ray results analized with T-Student test were statistically significant (Plt0005)

CONCLUSIONSThe timing of bone tissue healing around TMI implants overlap timing of a simple fracture of the jaw bones These results showed as early loading of PBR implants

inserted together bone grafts seems to be a valid technique to restore atrophic alveolar ridges shortening healing time and having quicker clinical case resolution

689

87th General Session amp Exhibition of the IADRMiami Florida - April 1-4 2009

CLINICAL AND HISTOLOGICAL EVALUATION OF ATROPHIC MAXILLARY RIDGES IMPLANT REHABILITATIONI VOZZA S ROSSI AM CARPIO E NICOLINI and G POMPA

Dental School Prosthodontics Department ldquoLa Sapienzardquo University Rome Italy

INTRODUCTION

The latest and new indications about implant surgery and the constant introduction on the market of new components and methodologies go hand in handwith the ever-increasing demand from our patients for a quicker and quicker functional rehabilitation Primary Bone Regeneration (PBR) is a mechanism ofnatural bone healing leading to consolidation of two bone segments in 6 weeks In Implant-Prosthodontics PBR implants let the patient have quickerprosthetic rehabilitation also in case of severe bone atrophy and after guided bone regeneration In fact with PBR implants itrsquos possible to load them justafter 45 days from implants insertion This depends on primary intention bone healing with direct formation of bone tissue close in contact with implants andwithout interposition of connective tissue The aim of this study was to evaluate early loading of PBR (Primary Bone Regeneration) implants insertedtogether with bone grafts in atrophic maxillary ridges

REFERENCES

Attard NJ Zarb GA Immediate and early implant loading protocols a review of clinical studies J Prosthet Dent 2005 Sep 94 (3) 242-58

Brochu JF Anderson JD Zarb GA The influence of early loading on bony crest height and stability a pilot study Int J Prosthodont 2005 Nov-Dec 18 (6) 506-12

Cornelini R Barone A Covani U Connective tissue grafts in postextraction implants with immediate restoration a prospective controlled clinical study Pract Proced Aesthet Dent 2008 Jul20(6)337-43

Esposito M Grusovin MG Achille H Coulthard P Worthington HV Interventions for replacing missing teeth different times for loading dental implants Cochrane Database Syst Rev 2009 Jan 21(1)CD003878

Friberg B Raghoebar GM A 5-year prospective multicenter study on 1-stage smooth-surface Branemark System implants with early loading in edentulous mandibles Int J Oral Maxillofac Implants 2008 May-Jun23(3)481-6

Malchiodi L Quaranta A Scarano A Quaranta M Jaw reconstruction with grafted autologous bone early insertion of osseointegrated implants and early prosthetic loading J Oral Maxillofac Surg 2006 Aug64(8)1190-8

Mannai C Early implant loading in severely resorbed maxilla using xenograft autograft and platelet-rich plasma in 97 patients J Oral Maxillofac Surg 2006 Sep64(9)1420-6

Lai HC Zhang ZY Zhuang LF Wang F Liu X Pu YP Early loading of ITI implants supporting maxillary fixed full-arch prostheses Clin Oral Implants Res 2008 Nov19(11)1129-34

Piattelli A Corigliano M Scarano A Quaranta M Bone reactions to early occlusal loading of two-stage titanium plasma-sprayed implants a pilot study in monkeys Int J Periodontics Restorative Dent 1997 Apr17(2)162-9

Sennerby L Gottlow J Clinical outcome of immediatelyearly loading of dental implants A literature review of recent controlled prospective clinical studies Aust Dent J 2008 Jun53 Suppl 1S82-8

MATERIALS AND METHODSIn our Prosthodontics Dept Sapienza University of Rome from November 2004 to June 2007 a sinus lifting was performed in 8 patients (56 years mean agemale gender initial bone height of 15 -2 mm and bone width of 5 mm) asking for a fixed implant-supported rehabilitation They signed an informed consentIn every patient 2root former PBR implants (TMIreg Pressing Dental San Marino Italy) having 325 diameter and 105mm length were inserted together witha bone graft material (Physiograftreg Ghimas) 25 months after maxillary sinus augmentation one of the implants was retrieved and processed forundecalcified histology while the other one was loaded The endoral X-rays have been executed to 0 2 6 9 and 12 months

RESULTSFrom the histomorphometric analysis the graft material residuals accounted for the 4698 of the bioptical volume marrow spaces for the 1876 and bonefor the 3287 (new bone 2262 native bone 1025) Well-mineralized regenerated bone with lamellar parallel-fibred structure and Haversian systemssurrounded the residual graft material particles The measured BIC amounted to 1694 No connective tissue was observed at the implant boundary surfaceFrom clinical point of view there was no implant failure at the 2nd stage neither mobility nor bleeding on probing The endoral X-rays showed a completebone defect filling and no change of the marginal bone level was observed Clinical and X-ray results analized with T-Student test were statistically significant

(Plt0005) CONCLUSIONSThese results showed as early loading of PBR implants inserted together with bone grafts appears to be suitable for maxillary sinus floor augmentation alsoin critical condition as minimal vertical bone height and shorter healing time

3389

Objectives The aim of this study was to obtain immediate bone reparation in only 6 wks and to predict primary bone apposition

without intermediate growth of the connective tissue

Methods We inserted 128 PBR (Primary Bone Reparation) implants (TMIreg Pressing Dental RSM) into 42 patients of both

genders aged between 29 and 68 yrs After 45 days 25 implants were removed from their sites carefully chosen so as not

to endanger either the final prosthesis plan or the patients health The removed samples were embedded in resin (Tecnovit

Kulzer) histologically prepared (EXAKT) and stained with hematoxylin eosin and methylene blue The same samples

were then examined histologically under an optical microscope (Zeiss and Leitz) at 50-100-200-400X

86th General Session and Exibition of the IADR ndash Metro Toronto Convention Centre Canada

Histologic evaluation of a PBR implant system study in manM CORIGLIANO1 S ROSSI2 AM CARPIO2 and S DI CARLO2

1International Academy of Implantoprosthesis and Osteoconnection Rome Italy 2University

of Rome Sapienza Italy

1 Schenk RK Histologie der Primarien Knocheilung Verh Dtsch ges pathol 1974 54 8-12

2 Corigliano M Vrespa G DrsquoAddona A Casolo F Impianto a guarigione primaria Dental Cadmos 1994 11 60-72

3 Piattelli A Paolantonio M Corigliano M Scarano A Immediate loading of titanium plasma-sprayed screw-shaped implants in man a clinical and histological report of two cases J Periodontol 199768591-

597

3 Corigliano M Barlattani A Gargari M Ottria L Andreana S La riparazione ossea primaria in implantoprotesi possibilitagrave tecnica ed applicazioni Quint Int 2002 910 359-370

4 Cooper LF Rahman A Moriarty J Chaffee N Sacco D Immediate mandibular rehabilitation with endosseous implants simultaneous extraction implant placement and loadingInt J Oral Maxillofac

Implants 200217(4)517-25

5 Gherlone E Albano F Vrespa G Falegatti G Capuano A Carico immediato su impianti post estrattivi immediati Implantologia 2004125-37

6 Forabosco A et al Impianti postestrattivi a carico immediato Doctor Os 200617(1)188-190

6

TMI reg Implant System is composed by

Fig1 Pilot Drill

Fig2 Osteotom ldquo UNICArdquo

Fig3 Implant

2

Results The quantity and the quality of the bone observed histologically

in connection with the radicular titanium prostheses following PBR

registered complete growth The BIC (Bone Implant Contact) measured

all around the removed implants averaged 85 Further there were no

necrotic zones associated with the resorption or substitution with

connective fibrous tissue

Conclusions Our histologic analysis demonstrates that the PBR

implant system is without doubt reliable Actually it permits a

great deal of bone to support the progressive load of dental

prostheses

2

Histological images coloured

with hematoxylineosin and

methilene blue

Surgycal phases

1 Drilling

2 Osteotomy with ldquoUNICArdquo

3 Radicular prostheses

insert

85th General Session amp Exhibition of the IADRNew Orleans 21-24 March 2007

EARLY LOADED IMPLANT SUPPORTED OVERDENTURE 3-YEAR FOLLOW-UP EVALUATIONS ROSSI I VOZZA A GIOVANNETTI MP BASILE S DI CARLO

Dental School Prosthodontics Department ldquoLa Sapienzardquo University Rome Italy

INTRODUCTION

Primary Bone Reparation PBR is a mechanism of natural bone healing determining consolidation of two bone segments in 6 weeks In Implantology PBR implantsconsent to patient having prosthetic rehabilitation briefly because it is possible to load them just in 45 days form fixture insertion This is possible thanking to firstintention bone healing with direct formation of bone tissue in contact with implant and without interposition of connective tissue Times of tissue reparationaround implants are superimposable to times of a simple fracture of maxilla The aim of this study was to evaluate perimplant marginal bone level on early loadedimplants supporting overdenture

REFERENCES

Attard NJ Zarb GA Immediate and early implant loading protocols a literature review of clinical studies J Prosthet Dent 200594(3)242-58

Brochu JF Anderson JD Zarb GA The influence of early loading on bony crest height and stability a pilot study Int J Prosthodont 200518(6)506-12

Chiapasco M Early and immediate restoration and loading of implants in completely edentulous patients Int J Oral Maxillofac Implants 200419 Suppl76-91

Mericske-Stern R Oetterli M Kiener P Mericske E A follow-up study of maxillary implants supporting an overdenture clinical and radiographic results Int J Oral Maxillofac Implants 200217(5)678-86

Misch CE Degidi M 5-year prospective study of immediateearly loading of fixed prostheses in completely edentulous jaw with a bone quality-based implant system Clin Implant Dent Relat Res 20035(1)17-28

Payne AG Tawse-Smith A Thomson WM Duncan WD Kumara R One-stage surgery and early loading of three implants for maxillary overdenture a 1-year report Clin Implant Dent Relat Res 20046(2)61-74

Raghoebar GM Friberg B Grunert I Hobkirk JA Tepper G Wendelhag I 3-year prospective multicenter study on one-stage implant surgery and early loading in the edentulous mandible Clin Implant Dent Relat Res 20035(1)39-46

Raghoebar GM Schoen P Meijer HJ Stellingsma K Vissink A Early loading of endosseous implants in the augmented maxilla a 1-year prospective study Clin Oral Implants Res 200314(6)697-702

MATERIALS AND METHODSIn our Prosthodontics Depratment La Sapienza University of Rome from May 2001 to December November 2003 we selected 30 patients (both sexes 49 yearsmean age no smokers) having maxillary total edentulism and asking for fixed prosthetic rehabilitation We inserted 128 root former implants (TMI PressingDental San Marino) they were early loaded after 45 days Minimum diameter was 42mm and minimum length was 13mm Before cementation of each finalrestoration we executed a periapical X-ray using a digital X-ray system (Den Optix Gendex Dentsply Int) The X-ray controls were executed after 1-3-6-9-12months and then yearly

RESULTSMarginal bone levels were evaluated by 2 different operators using a computerised measure system (Vix-win 2000 Gendex Dentsply Int) During the first yearthere was 028mm mean bone loss while during the next two years it was 017mm according to Albrektsson and Zarb implant success criteria (lt1mm during thefirst year and lt02mm during next years) X-ray results analized with T-Student test were statistically significant (Plt0005)

CONCLUSIONSParameters for the valuation of Implantology success have to be established before discussing about obtained results by this experimentation On the basis ofthis osseointegration definition clinical studies have to be purposed to survey the implant stability under functional loading In this order itrsquos necessary thatduring periodic controls implant mobility has to be evaluated and radiographic examinations have to be executed in a reproducible way for determining the stateof perimplant bone tissue health The implant success is evaluated on the following criteria by Albrektsson and Zarb 1) the not splinted implant has to be clinicallyimmovable 2) on the X-ray no perimplant radiotranslucency marks have to be present 3) vertical bone loss has to be lower than 1mm during the first year ofloading and lower than 02mm yearly in the following years 4) each implant has to be without marks or persistent andor not reversible symptoms for examplepain infections neuropathies paresthesis or penetration into the mandibular canal 5)prosthetic restoration has to satisfy function and aesthetics On thesepreliminary remarks in the anterior upper and lower sectors it should occur a success rate of 90 and 85 on long time respectively after 5 and 10 years in theposterior sectors these percentages have to be about 85 after 5 years and 80 after 10 years The obtained results from this experimentation are encouragingfully respecting implant success criteria by Albrektsson and Zarb These results showed as early loaded implants supporting overdenture are clinically andradiographically well osseointegrated

516

Introduction ndash It has been clearly proved by Ludwig through Fourierrsquos analysis [ Ludwig1993] that ultraweak signals are easly recognazed compared with the background noise if they present a patternthe signals the living matter is able to recognized among a variety of interferential signals are highly complex that is they are made up of different frequency bands Infact the complex signal reaches the biological system as a repetition of weak signals but connected among them in a fixed pattern and it is the

repetition of this pattern that distinguish the ldquotrue signalrdquo from the background noise The action of the CMF identifies as the sum of the effects of superimposed continous and pulsed magnetic fields on biological systemsOn the bone tissue is possible to obtain a neo-osteomorphogenesis increasing the gene expression of the morphogenetic proteins

and modulating the osteoclastogenetic proteins action The same results we can obtain on soft tissue The target of our clinical trial ldquoin vivordquo can demonstrate the effects of Combined Magnetic Field on the bone tissue in oral implantology

Methods 458 patients of both genders aged between 35 and 72 yrs underwent implant surgery associated with GBR according to the protocol of the PBR implant system 1024

fixtures were inserted by means of the TMIreg implant system (Pressing Dental RSM) The MET and CMF (MFI Italy) were applied to all patients for 74 days

Osteogenesis was radiologically controlled after 30 60 90 and 120 days All implants were loaded in 120 days

86th General Session and Exibition of the IADR ndash Metro Toronto Convention Centre Canada

Osteomorphogenesis biostimulated by CMF Combined Magnetic Fields M Corigliano1 S Rossi2 F Crescentini2 A Giovanetti2 S Di Carlo2

1International Academy of Implantoprosthesis and Osteoconnection Rome Italy 2 University of Rome Sapienza Italy

Induttori della TME

applicati

CMF-OS amp BR (1) TME (2) MFI Production

1

2

Stimulated morphogenetic proteins gene expression

and modulation of osteoclastogenesis by CMF induction

FGF-2 FGFai AngiopoietinTrombopoietin EGFConnexin 43 Cox-1 e Cox-2 BMP-2 BMP-4 c-myc e c-fosG-proteinCollagen I osteocalcin

Signal Molecules Erk frac12CREBIRS-1eNOS Cytokine IL1 TNFαTNFβTGkαTGFβPDGFIGF-1IGF-

2FGF Osteoclastogenesis Modulators OPGRank RANKL

M-CSFPGE2 EnzymesCytocrome-OssidaseNaK-ATPase hsp70

ornithine decarboxilase adinylate-cyclase protein kinase C

Densification Proteins and ions Osteocalcin Procollagenionized calcium ALPEstrogen-receptor system

Proteoglycans Collagen IIITP1 TPIII

Results All those who underwent implant therapy with GBR and were treated with the combination of MET and CMF showed complete mineralization in a shorter period of time than that commonly reported in these

cases

Conclusions The combined use of MET and CMF together with the PBR implant system can ameliorate and strengthen the physiological mechanisms of bone reparation

Materials CMF-OS ampBR Inductor of CMF multifrequential and presequential with continous magnetic fields Frequency from 1 to 80Hz Amplitude from 1

a 100μT and field amplifierconcentrator TME inductor of bifrequential fieldAmplitude from 5 a 50G for domiciliary use

Induction Method 6 inductions with CMF every 3 days for 12 mindie and TME domiciliary 30min X 2die X 45 days( inductors MFI Italy)

1 2 3

Soft Tissues unsuccessfull gengivoplasty Fase1 date 11042007 (2)date 11182007 (3)12062007 CMF treated 6 X 12 min induction sequenced every 3days

Ludwig W Magneitc Field Therapy In Alternative Medicine Future Medicine Publishing Washington (1993) McLeod BR Liboff AR Dynamic characteristics of membrane ions in multifield configurations of low-frequency

electromagnetic radiationBioelectromagnetics 19867(2)177-89

Blank M Goodman R Electromagnetic fields may act directly on DNADepartment of Physiology Columbia University New York New York 10032 USA mb32columbiaedu J Cell Biochem 1999 Dec 175(3)369-74

Fig1 Dental-Scan Fig2 Implants Fig3 RX results After 45 days

CMF-TME therapy 1 2 3

Abilitato allesercizio professionale presso lo stesso Ateneo con la votazione di 6060

Iscritto allAlbo Professionale degli Odontoiatri presso lOrdine dei Medici Chirurghi e degli Odontoiatri di Roma

con numero di iscrizione 4044

Master Internazionale Biennale di secondo livello in

Implantologia Orale e Riabilitazioni Protesiche

Direttore Prof Manlio Quaranta

Tesi finale pubblicata dal titolo

ldquoCarico precoce dalla sperimentazione alla clinicardquo

conseguito presso le Universitagrave degli studi di

Roma 1 ldquoLa Sapienza

Roma 2 Tor Vergata

ldquoG DAnnunzio di Chietirdquo

ldquoFaculdade de Medicina de Coimbra Departamento de Medicina Dentagraveria Estomatologia e Cirurgia Maxilo-Facialrdquo

Coimbra (Portugal)

Il 200605 consegue Borsa di Studio biennale presso LrsquoIstituto di Clinica Odontoiatrica dellrsquoUniversitagrave degli Studi di Roma ldquoLa Sapienzardquo per lo svolgimento di ldquoIndagine clinica sullrsquouso degli impianti TMIreg in Implantoprotesirdquo

Nellrsquo Anno Accademico 200607 egrave vincitore del concorso per il Dottorato di Ricerca in Malattie Odontostomatologiche XXII ciclo e svolge funzioni di Dottorando di Ricerca presso il Dipto di Scienze Odontostomatologiche Ideg Facoltagrave di Medicina e Chirurgia dellrsquo Universitagrave degli Studi di Roma ldquoSapienzardquo

Il 060409 consegue una seconda borsa di studio triennale presso il Dipto di Scienze Odontostomatologiche dellrsquoUniversitagrave degli Studi di Roma ldquoLa Sapienzardquo per lo svolgimento di una ricerca sullrsquouso degli impianti TMIreg con il protocollo clinico del carico immediato

Incaricato dallrsquo Anno Accademico 200304 dellrsquoinsegnamento di ldquoTecnologie Protesiche e di Laboratoriordquo (Titolare Prof Giorgio Pompa) presso il Corso di Laurea Specialistico in Odontoiatria e Protesi Dentaria dellrsquo Universitagrave degli Studi di Roma Sapienza

Docente del Master di II livello in ldquoImplantoprotesi in Odontostomatologiardquo

Direttore Prof Manlio Quaranta

presso

il Dipto di Scienze Odontostomatologiche dellrsquo Universitagrave di Roma ldquoSapienzardquo

Il 04 03 2010 consegue il titolo di Dottore di Ricerca in Malattie Odontostomatologiche presso il Dipartimanto di Scienze Odontostomatologiche della Ideg Facoltagrave di Medicina e Chirurgia dellrsquoUniversitagrave degli Studi di Roma ldquoSapienzardquo con una tesi dal titolo

ldquo VALUTAZIONE SPERIMENTALE CLINICO RADIOLOGICA SULLrsquoUSO DEGLI IMPIANTI A RIPARAZIONE OSSEA PRIMARIA NEL CARICO

IMMEDIATO POST ESTRATTIVOrdquo

Il 28052010 riceve il titolo di

Professore a contratto

per lrsquoinsegnamento di

ldquoImplantoprotesi in Odontostomatologiardquo

al Master di II livello presso il Dipto di Scienze Odontostomatologiche della Ideg

Facoltagrave di Medicina e Chirurgia Universitagrave di Roma ldquoSapienzardquo

Autore di numerose pubblicazioni in campo scientifico nazionale e internazionale

87th General Session amp Exhibition of the IADRMiami Florida - April 1-4 2009

CLINICAL EVALUATION OF OSSEOINTEGRATION OF IMPLANTS PLACED IN GRAFTED BONEI VOZZA S ROSSI L PICCOLI and M QUARANTA

Dental School Prosthodontics Department ldquoLa Sapienzardquo University Rome Italy

INTRODUCTION

Primary Bone Regeneration (PBR) is a mechanism of natural bone healing leading to consolidation of two bone segments in 6 weeks In Implant-Prosthodontics

PBR implants let the patient have quicker prosthetic rehabilitation also in case of severe bone atrophy and after guided bone regeneration In fact with PBR implantsitrsquos possible to load them just after 45 days from implants insertion This depends on primary intention bone healing with direct formation of bone tissue close incontact with implants and without interposition of connective tissue The aim of this study was to evaluate osseointegration in early loaded PBR implants insertedtogether with bone grafts in atrophic alveolar ridges

REFERENCES

Cornelini R Barone A Covani U Connective tissue grafts in postextraction implants with immediate restoration a prospective controlled clinical study Pract Proced Aesthet Dent 2008 Jul20(6)337-43

Esposito M Grusovin MG Achille H Coulthard P Worthington HV Interventions for replacing missing teeth different times for loading dental implants Cochrane Database Syst Rev 2009 Jan 21(1)CD003878

Friberg B Raghoebar GM et al A 5-year prospective multicenter study on 1-stage smooth-surface Branemark System implants with early loading in edentulous mandibles Int J Oral Maxillofac Implants 2008 May23(3)481-6

Lai HC Zhang ZY Zhuang LF Wang F Liu X Pu YP Early loading of ITI implants supporting maxillary fixed full-arch prostheses Clin Oral Implants Res 2008 Nov19(11)1129-34

Malchiodi L Quaranta A Scarano A Quaranta M Jaw reconstruction with grafted autologous bone early insertion of osseointegrated implants and early prosthetic loading J Oral Maxillofac Surg 2006 Aug64(8)1190-8

Mannai C Early implant loading in severely resorbed maxilla using xenograft autograft and platelet-rich plasma in 97 patients J Oral Maxillofac Surg 2006 Sep64(9)1420-6

Piattelli A Corigliano M Scarano A Quaranta M Bone reactions to early occlusal loading of two-stage titanium plasma-sprayed implants a pilot study in monkeys Int J Periodontics Restorative Dent 1997 Apr17(2)162-9

Sennerby L Gottlow J Clinical outcome of immediatelyearly loading of dental implants A literature review of recent controlled prospective clinical studies Aust Dent J 2008 Jun53 Suppl 1S82-8

MATERIALS AND METHODSIn our Prosthodontics Dept Sapienza University of Rome from November 2004 to October 2007 we selected 24 patients (both sexes 42 years mean age wellhealthy no smokers) having maxillary and mandibular partial atrophic alveolar ridges and asking for implant supported prostheses We inserted 78 rot ormer PBRimplants (TMIreg Pressing Dental San Marino Italy) together with a bone graft material (BioOss Geistlich) Minimum implant diameter was 375mm and minimumlength was 105mm The primary implant stability was estimated by RFA When the ISQ resulted ge 57 value in the 2nd stage surgery they were early loaded (15months from surgery) The ISQ values were subsequently estimated every month until the 6th month then at 9 and 12 months The endoral X-rays have beenexecuted to 0 2 6 9 and 12 months

RESULTSIn the 2nd stage surgery a complete bone defect filling was observed in all the cases except one that was characterized by partial bone defect filling (greater than50 and without flap dehiscence) The most significant ISQ values increase was observed in the first 2 months a further ISQ value increasing was observed until the3rd-4th month and successively the ISQ values levelled on constant shares At the end of the second month just 6 implants (77) of 5 different patients didnrsquot show57 ISQ value Among these implants 2 showed clinical mobility (M) in early time (third and fourth month) and they were removed and indicated like failures Theendoral X-ray didnrsquot show any change of the marginal bone level Clinical and X-ray results analized with T-Student test were statistically significant (Plt0005)

CONCLUSIONSThe timing of bone tissue healing around TMI implants overlap timing of a simple fracture of the jaw bones These results showed as early loading of PBR implants

inserted together bone grafts seems to be a valid technique to restore atrophic alveolar ridges shortening healing time and having quicker clinical case resolution

689

87th General Session amp Exhibition of the IADRMiami Florida - April 1-4 2009

CLINICAL AND HISTOLOGICAL EVALUATION OF ATROPHIC MAXILLARY RIDGES IMPLANT REHABILITATIONI VOZZA S ROSSI AM CARPIO E NICOLINI and G POMPA

Dental School Prosthodontics Department ldquoLa Sapienzardquo University Rome Italy

INTRODUCTION

The latest and new indications about implant surgery and the constant introduction on the market of new components and methodologies go hand in handwith the ever-increasing demand from our patients for a quicker and quicker functional rehabilitation Primary Bone Regeneration (PBR) is a mechanism ofnatural bone healing leading to consolidation of two bone segments in 6 weeks In Implant-Prosthodontics PBR implants let the patient have quickerprosthetic rehabilitation also in case of severe bone atrophy and after guided bone regeneration In fact with PBR implants itrsquos possible to load them justafter 45 days from implants insertion This depends on primary intention bone healing with direct formation of bone tissue close in contact with implants andwithout interposition of connective tissue The aim of this study was to evaluate early loading of PBR (Primary Bone Regeneration) implants insertedtogether with bone grafts in atrophic maxillary ridges

REFERENCES

Attard NJ Zarb GA Immediate and early implant loading protocols a review of clinical studies J Prosthet Dent 2005 Sep 94 (3) 242-58

Brochu JF Anderson JD Zarb GA The influence of early loading on bony crest height and stability a pilot study Int J Prosthodont 2005 Nov-Dec 18 (6) 506-12

Cornelini R Barone A Covani U Connective tissue grafts in postextraction implants with immediate restoration a prospective controlled clinical study Pract Proced Aesthet Dent 2008 Jul20(6)337-43

Esposito M Grusovin MG Achille H Coulthard P Worthington HV Interventions for replacing missing teeth different times for loading dental implants Cochrane Database Syst Rev 2009 Jan 21(1)CD003878

Friberg B Raghoebar GM A 5-year prospective multicenter study on 1-stage smooth-surface Branemark System implants with early loading in edentulous mandibles Int J Oral Maxillofac Implants 2008 May-Jun23(3)481-6

Malchiodi L Quaranta A Scarano A Quaranta M Jaw reconstruction with grafted autologous bone early insertion of osseointegrated implants and early prosthetic loading J Oral Maxillofac Surg 2006 Aug64(8)1190-8

Mannai C Early implant loading in severely resorbed maxilla using xenograft autograft and platelet-rich plasma in 97 patients J Oral Maxillofac Surg 2006 Sep64(9)1420-6

Lai HC Zhang ZY Zhuang LF Wang F Liu X Pu YP Early loading of ITI implants supporting maxillary fixed full-arch prostheses Clin Oral Implants Res 2008 Nov19(11)1129-34

Piattelli A Corigliano M Scarano A Quaranta M Bone reactions to early occlusal loading of two-stage titanium plasma-sprayed implants a pilot study in monkeys Int J Periodontics Restorative Dent 1997 Apr17(2)162-9

Sennerby L Gottlow J Clinical outcome of immediatelyearly loading of dental implants A literature review of recent controlled prospective clinical studies Aust Dent J 2008 Jun53 Suppl 1S82-8

MATERIALS AND METHODSIn our Prosthodontics Dept Sapienza University of Rome from November 2004 to June 2007 a sinus lifting was performed in 8 patients (56 years mean agemale gender initial bone height of 15 -2 mm and bone width of 5 mm) asking for a fixed implant-supported rehabilitation They signed an informed consentIn every patient 2root former PBR implants (TMIreg Pressing Dental San Marino Italy) having 325 diameter and 105mm length were inserted together witha bone graft material (Physiograftreg Ghimas) 25 months after maxillary sinus augmentation one of the implants was retrieved and processed forundecalcified histology while the other one was loaded The endoral X-rays have been executed to 0 2 6 9 and 12 months

RESULTSFrom the histomorphometric analysis the graft material residuals accounted for the 4698 of the bioptical volume marrow spaces for the 1876 and bonefor the 3287 (new bone 2262 native bone 1025) Well-mineralized regenerated bone with lamellar parallel-fibred structure and Haversian systemssurrounded the residual graft material particles The measured BIC amounted to 1694 No connective tissue was observed at the implant boundary surfaceFrom clinical point of view there was no implant failure at the 2nd stage neither mobility nor bleeding on probing The endoral X-rays showed a completebone defect filling and no change of the marginal bone level was observed Clinical and X-ray results analized with T-Student test were statistically significant

(Plt0005) CONCLUSIONSThese results showed as early loading of PBR implants inserted together with bone grafts appears to be suitable for maxillary sinus floor augmentation alsoin critical condition as minimal vertical bone height and shorter healing time

3389

Objectives The aim of this study was to obtain immediate bone reparation in only 6 wks and to predict primary bone apposition

without intermediate growth of the connective tissue

Methods We inserted 128 PBR (Primary Bone Reparation) implants (TMIreg Pressing Dental RSM) into 42 patients of both

genders aged between 29 and 68 yrs After 45 days 25 implants were removed from their sites carefully chosen so as not

to endanger either the final prosthesis plan or the patients health The removed samples were embedded in resin (Tecnovit

Kulzer) histologically prepared (EXAKT) and stained with hematoxylin eosin and methylene blue The same samples

were then examined histologically under an optical microscope (Zeiss and Leitz) at 50-100-200-400X

86th General Session and Exibition of the IADR ndash Metro Toronto Convention Centre Canada

Histologic evaluation of a PBR implant system study in manM CORIGLIANO1 S ROSSI2 AM CARPIO2 and S DI CARLO2

1International Academy of Implantoprosthesis and Osteoconnection Rome Italy 2University

of Rome Sapienza Italy

1 Schenk RK Histologie der Primarien Knocheilung Verh Dtsch ges pathol 1974 54 8-12

2 Corigliano M Vrespa G DrsquoAddona A Casolo F Impianto a guarigione primaria Dental Cadmos 1994 11 60-72

3 Piattelli A Paolantonio M Corigliano M Scarano A Immediate loading of titanium plasma-sprayed screw-shaped implants in man a clinical and histological report of two cases J Periodontol 199768591-

597

3 Corigliano M Barlattani A Gargari M Ottria L Andreana S La riparazione ossea primaria in implantoprotesi possibilitagrave tecnica ed applicazioni Quint Int 2002 910 359-370

4 Cooper LF Rahman A Moriarty J Chaffee N Sacco D Immediate mandibular rehabilitation with endosseous implants simultaneous extraction implant placement and loadingInt J Oral Maxillofac

Implants 200217(4)517-25

5 Gherlone E Albano F Vrespa G Falegatti G Capuano A Carico immediato su impianti post estrattivi immediati Implantologia 2004125-37

6 Forabosco A et al Impianti postestrattivi a carico immediato Doctor Os 200617(1)188-190

6

TMI reg Implant System is composed by

Fig1 Pilot Drill

Fig2 Osteotom ldquo UNICArdquo

Fig3 Implant

2

Results The quantity and the quality of the bone observed histologically

in connection with the radicular titanium prostheses following PBR

registered complete growth The BIC (Bone Implant Contact) measured

all around the removed implants averaged 85 Further there were no

necrotic zones associated with the resorption or substitution with

connective fibrous tissue

Conclusions Our histologic analysis demonstrates that the PBR

implant system is without doubt reliable Actually it permits a

great deal of bone to support the progressive load of dental

prostheses

2

Histological images coloured

with hematoxylineosin and

methilene blue

Surgycal phases

1 Drilling

2 Osteotomy with ldquoUNICArdquo

3 Radicular prostheses

insert

85th General Session amp Exhibition of the IADRNew Orleans 21-24 March 2007

EARLY LOADED IMPLANT SUPPORTED OVERDENTURE 3-YEAR FOLLOW-UP EVALUATIONS ROSSI I VOZZA A GIOVANNETTI MP BASILE S DI CARLO

Dental School Prosthodontics Department ldquoLa Sapienzardquo University Rome Italy

INTRODUCTION

Primary Bone Reparation PBR is a mechanism of natural bone healing determining consolidation of two bone segments in 6 weeks In Implantology PBR implantsconsent to patient having prosthetic rehabilitation briefly because it is possible to load them just in 45 days form fixture insertion This is possible thanking to firstintention bone healing with direct formation of bone tissue in contact with implant and without interposition of connective tissue Times of tissue reparationaround implants are superimposable to times of a simple fracture of maxilla The aim of this study was to evaluate perimplant marginal bone level on early loadedimplants supporting overdenture

REFERENCES

Attard NJ Zarb GA Immediate and early implant loading protocols a literature review of clinical studies J Prosthet Dent 200594(3)242-58

Brochu JF Anderson JD Zarb GA The influence of early loading on bony crest height and stability a pilot study Int J Prosthodont 200518(6)506-12

Chiapasco M Early and immediate restoration and loading of implants in completely edentulous patients Int J Oral Maxillofac Implants 200419 Suppl76-91

Mericske-Stern R Oetterli M Kiener P Mericske E A follow-up study of maxillary implants supporting an overdenture clinical and radiographic results Int J Oral Maxillofac Implants 200217(5)678-86

Misch CE Degidi M 5-year prospective study of immediateearly loading of fixed prostheses in completely edentulous jaw with a bone quality-based implant system Clin Implant Dent Relat Res 20035(1)17-28

Payne AG Tawse-Smith A Thomson WM Duncan WD Kumara R One-stage surgery and early loading of three implants for maxillary overdenture a 1-year report Clin Implant Dent Relat Res 20046(2)61-74

Raghoebar GM Friberg B Grunert I Hobkirk JA Tepper G Wendelhag I 3-year prospective multicenter study on one-stage implant surgery and early loading in the edentulous mandible Clin Implant Dent Relat Res 20035(1)39-46

Raghoebar GM Schoen P Meijer HJ Stellingsma K Vissink A Early loading of endosseous implants in the augmented maxilla a 1-year prospective study Clin Oral Implants Res 200314(6)697-702

MATERIALS AND METHODSIn our Prosthodontics Depratment La Sapienza University of Rome from May 2001 to December November 2003 we selected 30 patients (both sexes 49 yearsmean age no smokers) having maxillary total edentulism and asking for fixed prosthetic rehabilitation We inserted 128 root former implants (TMI PressingDental San Marino) they were early loaded after 45 days Minimum diameter was 42mm and minimum length was 13mm Before cementation of each finalrestoration we executed a periapical X-ray using a digital X-ray system (Den Optix Gendex Dentsply Int) The X-ray controls were executed after 1-3-6-9-12months and then yearly

RESULTSMarginal bone levels were evaluated by 2 different operators using a computerised measure system (Vix-win 2000 Gendex Dentsply Int) During the first yearthere was 028mm mean bone loss while during the next two years it was 017mm according to Albrektsson and Zarb implant success criteria (lt1mm during thefirst year and lt02mm during next years) X-ray results analized with T-Student test were statistically significant (Plt0005)

CONCLUSIONSParameters for the valuation of Implantology success have to be established before discussing about obtained results by this experimentation On the basis ofthis osseointegration definition clinical studies have to be purposed to survey the implant stability under functional loading In this order itrsquos necessary thatduring periodic controls implant mobility has to be evaluated and radiographic examinations have to be executed in a reproducible way for determining the stateof perimplant bone tissue health The implant success is evaluated on the following criteria by Albrektsson and Zarb 1) the not splinted implant has to be clinicallyimmovable 2) on the X-ray no perimplant radiotranslucency marks have to be present 3) vertical bone loss has to be lower than 1mm during the first year ofloading and lower than 02mm yearly in the following years 4) each implant has to be without marks or persistent andor not reversible symptoms for examplepain infections neuropathies paresthesis or penetration into the mandibular canal 5)prosthetic restoration has to satisfy function and aesthetics On thesepreliminary remarks in the anterior upper and lower sectors it should occur a success rate of 90 and 85 on long time respectively after 5 and 10 years in theposterior sectors these percentages have to be about 85 after 5 years and 80 after 10 years The obtained results from this experimentation are encouragingfully respecting implant success criteria by Albrektsson and Zarb These results showed as early loaded implants supporting overdenture are clinically andradiographically well osseointegrated

516

Introduction ndash It has been clearly proved by Ludwig through Fourierrsquos analysis [ Ludwig1993] that ultraweak signals are easly recognazed compared with the background noise if they present a patternthe signals the living matter is able to recognized among a variety of interferential signals are highly complex that is they are made up of different frequency bands Infact the complex signal reaches the biological system as a repetition of weak signals but connected among them in a fixed pattern and it is the

repetition of this pattern that distinguish the ldquotrue signalrdquo from the background noise The action of the CMF identifies as the sum of the effects of superimposed continous and pulsed magnetic fields on biological systemsOn the bone tissue is possible to obtain a neo-osteomorphogenesis increasing the gene expression of the morphogenetic proteins

and modulating the osteoclastogenetic proteins action The same results we can obtain on soft tissue The target of our clinical trial ldquoin vivordquo can demonstrate the effects of Combined Magnetic Field on the bone tissue in oral implantology

Methods 458 patients of both genders aged between 35 and 72 yrs underwent implant surgery associated with GBR according to the protocol of the PBR implant system 1024

fixtures were inserted by means of the TMIreg implant system (Pressing Dental RSM) The MET and CMF (MFI Italy) were applied to all patients for 74 days

Osteogenesis was radiologically controlled after 30 60 90 and 120 days All implants were loaded in 120 days

86th General Session and Exibition of the IADR ndash Metro Toronto Convention Centre Canada

Osteomorphogenesis biostimulated by CMF Combined Magnetic Fields M Corigliano1 S Rossi2 F Crescentini2 A Giovanetti2 S Di Carlo2

1International Academy of Implantoprosthesis and Osteoconnection Rome Italy 2 University of Rome Sapienza Italy

Induttori della TME

applicati

CMF-OS amp BR (1) TME (2) MFI Production

1

2

Stimulated morphogenetic proteins gene expression

and modulation of osteoclastogenesis by CMF induction

FGF-2 FGFai AngiopoietinTrombopoietin EGFConnexin 43 Cox-1 e Cox-2 BMP-2 BMP-4 c-myc e c-fosG-proteinCollagen I osteocalcin

Signal Molecules Erk frac12CREBIRS-1eNOS Cytokine IL1 TNFαTNFβTGkαTGFβPDGFIGF-1IGF-

2FGF Osteoclastogenesis Modulators OPGRank RANKL

M-CSFPGE2 EnzymesCytocrome-OssidaseNaK-ATPase hsp70

ornithine decarboxilase adinylate-cyclase protein kinase C

Densification Proteins and ions Osteocalcin Procollagenionized calcium ALPEstrogen-receptor system

Proteoglycans Collagen IIITP1 TPIII

Results All those who underwent implant therapy with GBR and were treated with the combination of MET and CMF showed complete mineralization in a shorter period of time than that commonly reported in these

cases

Conclusions The combined use of MET and CMF together with the PBR implant system can ameliorate and strengthen the physiological mechanisms of bone reparation

Materials CMF-OS ampBR Inductor of CMF multifrequential and presequential with continous magnetic fields Frequency from 1 to 80Hz Amplitude from 1

a 100μT and field amplifierconcentrator TME inductor of bifrequential fieldAmplitude from 5 a 50G for domiciliary use

Induction Method 6 inductions with CMF every 3 days for 12 mindie and TME domiciliary 30min X 2die X 45 days( inductors MFI Italy)

1 2 3

Soft Tissues unsuccessfull gengivoplasty Fase1 date 11042007 (2)date 11182007 (3)12062007 CMF treated 6 X 12 min induction sequenced every 3days

Ludwig W Magneitc Field Therapy In Alternative Medicine Future Medicine Publishing Washington (1993) McLeod BR Liboff AR Dynamic characteristics of membrane ions in multifield configurations of low-frequency

electromagnetic radiationBioelectromagnetics 19867(2)177-89

Blank M Goodman R Electromagnetic fields may act directly on DNADepartment of Physiology Columbia University New York New York 10032 USA mb32columbiaedu J Cell Biochem 1999 Dec 175(3)369-74

Fig1 Dental-Scan Fig2 Implants Fig3 RX results After 45 days

CMF-TME therapy 1 2 3

Master Internazionale Biennale di secondo livello in

Implantologia Orale e Riabilitazioni Protesiche

Direttore Prof Manlio Quaranta

Tesi finale pubblicata dal titolo

ldquoCarico precoce dalla sperimentazione alla clinicardquo

conseguito presso le Universitagrave degli studi di

Roma 1 ldquoLa Sapienza

Roma 2 Tor Vergata

ldquoG DAnnunzio di Chietirdquo

ldquoFaculdade de Medicina de Coimbra Departamento de Medicina Dentagraveria Estomatologia e Cirurgia Maxilo-Facialrdquo

Coimbra (Portugal)

Il 200605 consegue Borsa di Studio biennale presso LrsquoIstituto di Clinica Odontoiatrica dellrsquoUniversitagrave degli Studi di Roma ldquoLa Sapienzardquo per lo svolgimento di ldquoIndagine clinica sullrsquouso degli impianti TMIreg in Implantoprotesirdquo

Nellrsquo Anno Accademico 200607 egrave vincitore del concorso per il Dottorato di Ricerca in Malattie Odontostomatologiche XXII ciclo e svolge funzioni di Dottorando di Ricerca presso il Dipto di Scienze Odontostomatologiche Ideg Facoltagrave di Medicina e Chirurgia dellrsquo Universitagrave degli Studi di Roma ldquoSapienzardquo

Il 060409 consegue una seconda borsa di studio triennale presso il Dipto di Scienze Odontostomatologiche dellrsquoUniversitagrave degli Studi di Roma ldquoLa Sapienzardquo per lo svolgimento di una ricerca sullrsquouso degli impianti TMIreg con il protocollo clinico del carico immediato

Incaricato dallrsquo Anno Accademico 200304 dellrsquoinsegnamento di ldquoTecnologie Protesiche e di Laboratoriordquo (Titolare Prof Giorgio Pompa) presso il Corso di Laurea Specialistico in Odontoiatria e Protesi Dentaria dellrsquo Universitagrave degli Studi di Roma Sapienza

Docente del Master di II livello in ldquoImplantoprotesi in Odontostomatologiardquo

Direttore Prof Manlio Quaranta

presso

il Dipto di Scienze Odontostomatologiche dellrsquo Universitagrave di Roma ldquoSapienzardquo

Il 04 03 2010 consegue il titolo di Dottore di Ricerca in Malattie Odontostomatologiche presso il Dipartimanto di Scienze Odontostomatologiche della Ideg Facoltagrave di Medicina e Chirurgia dellrsquoUniversitagrave degli Studi di Roma ldquoSapienzardquo con una tesi dal titolo

ldquo VALUTAZIONE SPERIMENTALE CLINICO RADIOLOGICA SULLrsquoUSO DEGLI IMPIANTI A RIPARAZIONE OSSEA PRIMARIA NEL CARICO

IMMEDIATO POST ESTRATTIVOrdquo

Il 28052010 riceve il titolo di

Professore a contratto

per lrsquoinsegnamento di

ldquoImplantoprotesi in Odontostomatologiardquo

al Master di II livello presso il Dipto di Scienze Odontostomatologiche della Ideg

Facoltagrave di Medicina e Chirurgia Universitagrave di Roma ldquoSapienzardquo

Autore di numerose pubblicazioni in campo scientifico nazionale e internazionale

87th General Session amp Exhibition of the IADRMiami Florida - April 1-4 2009

CLINICAL EVALUATION OF OSSEOINTEGRATION OF IMPLANTS PLACED IN GRAFTED BONEI VOZZA S ROSSI L PICCOLI and M QUARANTA

Dental School Prosthodontics Department ldquoLa Sapienzardquo University Rome Italy

INTRODUCTION

Primary Bone Regeneration (PBR) is a mechanism of natural bone healing leading to consolidation of two bone segments in 6 weeks In Implant-Prosthodontics

PBR implants let the patient have quicker prosthetic rehabilitation also in case of severe bone atrophy and after guided bone regeneration In fact with PBR implantsitrsquos possible to load them just after 45 days from implants insertion This depends on primary intention bone healing with direct formation of bone tissue close incontact with implants and without interposition of connective tissue The aim of this study was to evaluate osseointegration in early loaded PBR implants insertedtogether with bone grafts in atrophic alveolar ridges

REFERENCES

Cornelini R Barone A Covani U Connective tissue grafts in postextraction implants with immediate restoration a prospective controlled clinical study Pract Proced Aesthet Dent 2008 Jul20(6)337-43

Esposito M Grusovin MG Achille H Coulthard P Worthington HV Interventions for replacing missing teeth different times for loading dental implants Cochrane Database Syst Rev 2009 Jan 21(1)CD003878

Friberg B Raghoebar GM et al A 5-year prospective multicenter study on 1-stage smooth-surface Branemark System implants with early loading in edentulous mandibles Int J Oral Maxillofac Implants 2008 May23(3)481-6

Lai HC Zhang ZY Zhuang LF Wang F Liu X Pu YP Early loading of ITI implants supporting maxillary fixed full-arch prostheses Clin Oral Implants Res 2008 Nov19(11)1129-34

Malchiodi L Quaranta A Scarano A Quaranta M Jaw reconstruction with grafted autologous bone early insertion of osseointegrated implants and early prosthetic loading J Oral Maxillofac Surg 2006 Aug64(8)1190-8

Mannai C Early implant loading in severely resorbed maxilla using xenograft autograft and platelet-rich plasma in 97 patients J Oral Maxillofac Surg 2006 Sep64(9)1420-6

Piattelli A Corigliano M Scarano A Quaranta M Bone reactions to early occlusal loading of two-stage titanium plasma-sprayed implants a pilot study in monkeys Int J Periodontics Restorative Dent 1997 Apr17(2)162-9

Sennerby L Gottlow J Clinical outcome of immediatelyearly loading of dental implants A literature review of recent controlled prospective clinical studies Aust Dent J 2008 Jun53 Suppl 1S82-8

MATERIALS AND METHODSIn our Prosthodontics Dept Sapienza University of Rome from November 2004 to October 2007 we selected 24 patients (both sexes 42 years mean age wellhealthy no smokers) having maxillary and mandibular partial atrophic alveolar ridges and asking for implant supported prostheses We inserted 78 rot ormer PBRimplants (TMIreg Pressing Dental San Marino Italy) together with a bone graft material (BioOss Geistlich) Minimum implant diameter was 375mm and minimumlength was 105mm The primary implant stability was estimated by RFA When the ISQ resulted ge 57 value in the 2nd stage surgery they were early loaded (15months from surgery) The ISQ values were subsequently estimated every month until the 6th month then at 9 and 12 months The endoral X-rays have beenexecuted to 0 2 6 9 and 12 months

RESULTSIn the 2nd stage surgery a complete bone defect filling was observed in all the cases except one that was characterized by partial bone defect filling (greater than50 and without flap dehiscence) The most significant ISQ values increase was observed in the first 2 months a further ISQ value increasing was observed until the3rd-4th month and successively the ISQ values levelled on constant shares At the end of the second month just 6 implants (77) of 5 different patients didnrsquot show57 ISQ value Among these implants 2 showed clinical mobility (M) in early time (third and fourth month) and they were removed and indicated like failures Theendoral X-ray didnrsquot show any change of the marginal bone level Clinical and X-ray results analized with T-Student test were statistically significant (Plt0005)

CONCLUSIONSThe timing of bone tissue healing around TMI implants overlap timing of a simple fracture of the jaw bones These results showed as early loading of PBR implants

inserted together bone grafts seems to be a valid technique to restore atrophic alveolar ridges shortening healing time and having quicker clinical case resolution

689

87th General Session amp Exhibition of the IADRMiami Florida - April 1-4 2009

CLINICAL AND HISTOLOGICAL EVALUATION OF ATROPHIC MAXILLARY RIDGES IMPLANT REHABILITATIONI VOZZA S ROSSI AM CARPIO E NICOLINI and G POMPA

Dental School Prosthodontics Department ldquoLa Sapienzardquo University Rome Italy

INTRODUCTION

The latest and new indications about implant surgery and the constant introduction on the market of new components and methodologies go hand in handwith the ever-increasing demand from our patients for a quicker and quicker functional rehabilitation Primary Bone Regeneration (PBR) is a mechanism ofnatural bone healing leading to consolidation of two bone segments in 6 weeks In Implant-Prosthodontics PBR implants let the patient have quickerprosthetic rehabilitation also in case of severe bone atrophy and after guided bone regeneration In fact with PBR implants itrsquos possible to load them justafter 45 days from implants insertion This depends on primary intention bone healing with direct formation of bone tissue close in contact with implants andwithout interposition of connective tissue The aim of this study was to evaluate early loading of PBR (Primary Bone Regeneration) implants insertedtogether with bone grafts in atrophic maxillary ridges

REFERENCES

Attard NJ Zarb GA Immediate and early implant loading protocols a review of clinical studies J Prosthet Dent 2005 Sep 94 (3) 242-58

Brochu JF Anderson JD Zarb GA The influence of early loading on bony crest height and stability a pilot study Int J Prosthodont 2005 Nov-Dec 18 (6) 506-12

Cornelini R Barone A Covani U Connective tissue grafts in postextraction implants with immediate restoration a prospective controlled clinical study Pract Proced Aesthet Dent 2008 Jul20(6)337-43

Esposito M Grusovin MG Achille H Coulthard P Worthington HV Interventions for replacing missing teeth different times for loading dental implants Cochrane Database Syst Rev 2009 Jan 21(1)CD003878

Friberg B Raghoebar GM A 5-year prospective multicenter study on 1-stage smooth-surface Branemark System implants with early loading in edentulous mandibles Int J Oral Maxillofac Implants 2008 May-Jun23(3)481-6

Malchiodi L Quaranta A Scarano A Quaranta M Jaw reconstruction with grafted autologous bone early insertion of osseointegrated implants and early prosthetic loading J Oral Maxillofac Surg 2006 Aug64(8)1190-8

Mannai C Early implant loading in severely resorbed maxilla using xenograft autograft and platelet-rich plasma in 97 patients J Oral Maxillofac Surg 2006 Sep64(9)1420-6

Lai HC Zhang ZY Zhuang LF Wang F Liu X Pu YP Early loading of ITI implants supporting maxillary fixed full-arch prostheses Clin Oral Implants Res 2008 Nov19(11)1129-34

Piattelli A Corigliano M Scarano A Quaranta M Bone reactions to early occlusal loading of two-stage titanium plasma-sprayed implants a pilot study in monkeys Int J Periodontics Restorative Dent 1997 Apr17(2)162-9

Sennerby L Gottlow J Clinical outcome of immediatelyearly loading of dental implants A literature review of recent controlled prospective clinical studies Aust Dent J 2008 Jun53 Suppl 1S82-8

MATERIALS AND METHODSIn our Prosthodontics Dept Sapienza University of Rome from November 2004 to June 2007 a sinus lifting was performed in 8 patients (56 years mean agemale gender initial bone height of 15 -2 mm and bone width of 5 mm) asking for a fixed implant-supported rehabilitation They signed an informed consentIn every patient 2root former PBR implants (TMIreg Pressing Dental San Marino Italy) having 325 diameter and 105mm length were inserted together witha bone graft material (Physiograftreg Ghimas) 25 months after maxillary sinus augmentation one of the implants was retrieved and processed forundecalcified histology while the other one was loaded The endoral X-rays have been executed to 0 2 6 9 and 12 months

RESULTSFrom the histomorphometric analysis the graft material residuals accounted for the 4698 of the bioptical volume marrow spaces for the 1876 and bonefor the 3287 (new bone 2262 native bone 1025) Well-mineralized regenerated bone with lamellar parallel-fibred structure and Haversian systemssurrounded the residual graft material particles The measured BIC amounted to 1694 No connective tissue was observed at the implant boundary surfaceFrom clinical point of view there was no implant failure at the 2nd stage neither mobility nor bleeding on probing The endoral X-rays showed a completebone defect filling and no change of the marginal bone level was observed Clinical and X-ray results analized with T-Student test were statistically significant

(Plt0005) CONCLUSIONSThese results showed as early loading of PBR implants inserted together with bone grafts appears to be suitable for maxillary sinus floor augmentation alsoin critical condition as minimal vertical bone height and shorter healing time

3389

Objectives The aim of this study was to obtain immediate bone reparation in only 6 wks and to predict primary bone apposition

without intermediate growth of the connective tissue

Methods We inserted 128 PBR (Primary Bone Reparation) implants (TMIreg Pressing Dental RSM) into 42 patients of both

genders aged between 29 and 68 yrs After 45 days 25 implants were removed from their sites carefully chosen so as not

to endanger either the final prosthesis plan or the patients health The removed samples were embedded in resin (Tecnovit

Kulzer) histologically prepared (EXAKT) and stained with hematoxylin eosin and methylene blue The same samples

were then examined histologically under an optical microscope (Zeiss and Leitz) at 50-100-200-400X

86th General Session and Exibition of the IADR ndash Metro Toronto Convention Centre Canada

Histologic evaluation of a PBR implant system study in manM CORIGLIANO1 S ROSSI2 AM CARPIO2 and S DI CARLO2

1International Academy of Implantoprosthesis and Osteoconnection Rome Italy 2University

of Rome Sapienza Italy

1 Schenk RK Histologie der Primarien Knocheilung Verh Dtsch ges pathol 1974 54 8-12

2 Corigliano M Vrespa G DrsquoAddona A Casolo F Impianto a guarigione primaria Dental Cadmos 1994 11 60-72

3 Piattelli A Paolantonio M Corigliano M Scarano A Immediate loading of titanium plasma-sprayed screw-shaped implants in man a clinical and histological report of two cases J Periodontol 199768591-

597

3 Corigliano M Barlattani A Gargari M Ottria L Andreana S La riparazione ossea primaria in implantoprotesi possibilitagrave tecnica ed applicazioni Quint Int 2002 910 359-370

4 Cooper LF Rahman A Moriarty J Chaffee N Sacco D Immediate mandibular rehabilitation with endosseous implants simultaneous extraction implant placement and loadingInt J Oral Maxillofac

Implants 200217(4)517-25

5 Gherlone E Albano F Vrespa G Falegatti G Capuano A Carico immediato su impianti post estrattivi immediati Implantologia 2004125-37

6 Forabosco A et al Impianti postestrattivi a carico immediato Doctor Os 200617(1)188-190

6

TMI reg Implant System is composed by

Fig1 Pilot Drill

Fig2 Osteotom ldquo UNICArdquo

Fig3 Implant

2

Results The quantity and the quality of the bone observed histologically

in connection with the radicular titanium prostheses following PBR

registered complete growth The BIC (Bone Implant Contact) measured

all around the removed implants averaged 85 Further there were no

necrotic zones associated with the resorption or substitution with

connective fibrous tissue

Conclusions Our histologic analysis demonstrates that the PBR

implant system is without doubt reliable Actually it permits a

great deal of bone to support the progressive load of dental

prostheses

2

Histological images coloured

with hematoxylineosin and

methilene blue

Surgycal phases

1 Drilling

2 Osteotomy with ldquoUNICArdquo

3 Radicular prostheses

insert

85th General Session amp Exhibition of the IADRNew Orleans 21-24 March 2007

EARLY LOADED IMPLANT SUPPORTED OVERDENTURE 3-YEAR FOLLOW-UP EVALUATIONS ROSSI I VOZZA A GIOVANNETTI MP BASILE S DI CARLO

Dental School Prosthodontics Department ldquoLa Sapienzardquo University Rome Italy

INTRODUCTION

Primary Bone Reparation PBR is a mechanism of natural bone healing determining consolidation of two bone segments in 6 weeks In Implantology PBR implantsconsent to patient having prosthetic rehabilitation briefly because it is possible to load them just in 45 days form fixture insertion This is possible thanking to firstintention bone healing with direct formation of bone tissue in contact with implant and without interposition of connective tissue Times of tissue reparationaround implants are superimposable to times of a simple fracture of maxilla The aim of this study was to evaluate perimplant marginal bone level on early loadedimplants supporting overdenture

REFERENCES

Attard NJ Zarb GA Immediate and early implant loading protocols a literature review of clinical studies J Prosthet Dent 200594(3)242-58

Brochu JF Anderson JD Zarb GA The influence of early loading on bony crest height and stability a pilot study Int J Prosthodont 200518(6)506-12

Chiapasco M Early and immediate restoration and loading of implants in completely edentulous patients Int J Oral Maxillofac Implants 200419 Suppl76-91

Mericske-Stern R Oetterli M Kiener P Mericske E A follow-up study of maxillary implants supporting an overdenture clinical and radiographic results Int J Oral Maxillofac Implants 200217(5)678-86

Misch CE Degidi M 5-year prospective study of immediateearly loading of fixed prostheses in completely edentulous jaw with a bone quality-based implant system Clin Implant Dent Relat Res 20035(1)17-28

Payne AG Tawse-Smith A Thomson WM Duncan WD Kumara R One-stage surgery and early loading of three implants for maxillary overdenture a 1-year report Clin Implant Dent Relat Res 20046(2)61-74

Raghoebar GM Friberg B Grunert I Hobkirk JA Tepper G Wendelhag I 3-year prospective multicenter study on one-stage implant surgery and early loading in the edentulous mandible Clin Implant Dent Relat Res 20035(1)39-46

Raghoebar GM Schoen P Meijer HJ Stellingsma K Vissink A Early loading of endosseous implants in the augmented maxilla a 1-year prospective study Clin Oral Implants Res 200314(6)697-702

MATERIALS AND METHODSIn our Prosthodontics Depratment La Sapienza University of Rome from May 2001 to December November 2003 we selected 30 patients (both sexes 49 yearsmean age no smokers) having maxillary total edentulism and asking for fixed prosthetic rehabilitation We inserted 128 root former implants (TMI PressingDental San Marino) they were early loaded after 45 days Minimum diameter was 42mm and minimum length was 13mm Before cementation of each finalrestoration we executed a periapical X-ray using a digital X-ray system (Den Optix Gendex Dentsply Int) The X-ray controls were executed after 1-3-6-9-12months and then yearly

RESULTSMarginal bone levels were evaluated by 2 different operators using a computerised measure system (Vix-win 2000 Gendex Dentsply Int) During the first yearthere was 028mm mean bone loss while during the next two years it was 017mm according to Albrektsson and Zarb implant success criteria (lt1mm during thefirst year and lt02mm during next years) X-ray results analized with T-Student test were statistically significant (Plt0005)

CONCLUSIONSParameters for the valuation of Implantology success have to be established before discussing about obtained results by this experimentation On the basis ofthis osseointegration definition clinical studies have to be purposed to survey the implant stability under functional loading In this order itrsquos necessary thatduring periodic controls implant mobility has to be evaluated and radiographic examinations have to be executed in a reproducible way for determining the stateof perimplant bone tissue health The implant success is evaluated on the following criteria by Albrektsson and Zarb 1) the not splinted implant has to be clinicallyimmovable 2) on the X-ray no perimplant radiotranslucency marks have to be present 3) vertical bone loss has to be lower than 1mm during the first year ofloading and lower than 02mm yearly in the following years 4) each implant has to be without marks or persistent andor not reversible symptoms for examplepain infections neuropathies paresthesis or penetration into the mandibular canal 5)prosthetic restoration has to satisfy function and aesthetics On thesepreliminary remarks in the anterior upper and lower sectors it should occur a success rate of 90 and 85 on long time respectively after 5 and 10 years in theposterior sectors these percentages have to be about 85 after 5 years and 80 after 10 years The obtained results from this experimentation are encouragingfully respecting implant success criteria by Albrektsson and Zarb These results showed as early loaded implants supporting overdenture are clinically andradiographically well osseointegrated

516

Introduction ndash It has been clearly proved by Ludwig through Fourierrsquos analysis [ Ludwig1993] that ultraweak signals are easly recognazed compared with the background noise if they present a patternthe signals the living matter is able to recognized among a variety of interferential signals are highly complex that is they are made up of different frequency bands Infact the complex signal reaches the biological system as a repetition of weak signals but connected among them in a fixed pattern and it is the

repetition of this pattern that distinguish the ldquotrue signalrdquo from the background noise The action of the CMF identifies as the sum of the effects of superimposed continous and pulsed magnetic fields on biological systemsOn the bone tissue is possible to obtain a neo-osteomorphogenesis increasing the gene expression of the morphogenetic proteins

and modulating the osteoclastogenetic proteins action The same results we can obtain on soft tissue The target of our clinical trial ldquoin vivordquo can demonstrate the effects of Combined Magnetic Field on the bone tissue in oral implantology

Methods 458 patients of both genders aged between 35 and 72 yrs underwent implant surgery associated with GBR according to the protocol of the PBR implant system 1024

fixtures were inserted by means of the TMIreg implant system (Pressing Dental RSM) The MET and CMF (MFI Italy) were applied to all patients for 74 days

Osteogenesis was radiologically controlled after 30 60 90 and 120 days All implants were loaded in 120 days

86th General Session and Exibition of the IADR ndash Metro Toronto Convention Centre Canada

Osteomorphogenesis biostimulated by CMF Combined Magnetic Fields M Corigliano1 S Rossi2 F Crescentini2 A Giovanetti2 S Di Carlo2

1International Academy of Implantoprosthesis and Osteoconnection Rome Italy 2 University of Rome Sapienza Italy

Induttori della TME

applicati

CMF-OS amp BR (1) TME (2) MFI Production

1

2

Stimulated morphogenetic proteins gene expression

and modulation of osteoclastogenesis by CMF induction

FGF-2 FGFai AngiopoietinTrombopoietin EGFConnexin 43 Cox-1 e Cox-2 BMP-2 BMP-4 c-myc e c-fosG-proteinCollagen I osteocalcin

Signal Molecules Erk frac12CREBIRS-1eNOS Cytokine IL1 TNFαTNFβTGkαTGFβPDGFIGF-1IGF-

2FGF Osteoclastogenesis Modulators OPGRank RANKL

M-CSFPGE2 EnzymesCytocrome-OssidaseNaK-ATPase hsp70

ornithine decarboxilase adinylate-cyclase protein kinase C

Densification Proteins and ions Osteocalcin Procollagenionized calcium ALPEstrogen-receptor system

Proteoglycans Collagen IIITP1 TPIII

Results All those who underwent implant therapy with GBR and were treated with the combination of MET and CMF showed complete mineralization in a shorter period of time than that commonly reported in these

cases

Conclusions The combined use of MET and CMF together with the PBR implant system can ameliorate and strengthen the physiological mechanisms of bone reparation

Materials CMF-OS ampBR Inductor of CMF multifrequential and presequential with continous magnetic fields Frequency from 1 to 80Hz Amplitude from 1

a 100μT and field amplifierconcentrator TME inductor of bifrequential fieldAmplitude from 5 a 50G for domiciliary use

Induction Method 6 inductions with CMF every 3 days for 12 mindie and TME domiciliary 30min X 2die X 45 days( inductors MFI Italy)

1 2 3

Soft Tissues unsuccessfull gengivoplasty Fase1 date 11042007 (2)date 11182007 (3)12062007 CMF treated 6 X 12 min induction sequenced every 3days

Ludwig W Magneitc Field Therapy In Alternative Medicine Future Medicine Publishing Washington (1993) McLeod BR Liboff AR Dynamic characteristics of membrane ions in multifield configurations of low-frequency

electromagnetic radiationBioelectromagnetics 19867(2)177-89

Blank M Goodman R Electromagnetic fields may act directly on DNADepartment of Physiology Columbia University New York New York 10032 USA mb32columbiaedu J Cell Biochem 1999 Dec 175(3)369-74

Fig1 Dental-Scan Fig2 Implants Fig3 RX results After 45 days

CMF-TME therapy 1 2 3

conseguito presso le Universitagrave degli studi di

Roma 1 ldquoLa Sapienza

Roma 2 Tor Vergata

ldquoG DAnnunzio di Chietirdquo

ldquoFaculdade de Medicina de Coimbra Departamento de Medicina Dentagraveria Estomatologia e Cirurgia Maxilo-Facialrdquo

Coimbra (Portugal)

Il 200605 consegue Borsa di Studio biennale presso LrsquoIstituto di Clinica Odontoiatrica dellrsquoUniversitagrave degli Studi di Roma ldquoLa Sapienzardquo per lo svolgimento di ldquoIndagine clinica sullrsquouso degli impianti TMIreg in Implantoprotesirdquo

Nellrsquo Anno Accademico 200607 egrave vincitore del concorso per il Dottorato di Ricerca in Malattie Odontostomatologiche XXII ciclo e svolge funzioni di Dottorando di Ricerca presso il Dipto di Scienze Odontostomatologiche Ideg Facoltagrave di Medicina e Chirurgia dellrsquo Universitagrave degli Studi di Roma ldquoSapienzardquo

Il 060409 consegue una seconda borsa di studio triennale presso il Dipto di Scienze Odontostomatologiche dellrsquoUniversitagrave degli Studi di Roma ldquoLa Sapienzardquo per lo svolgimento di una ricerca sullrsquouso degli impianti TMIreg con il protocollo clinico del carico immediato

Incaricato dallrsquo Anno Accademico 200304 dellrsquoinsegnamento di ldquoTecnologie Protesiche e di Laboratoriordquo (Titolare Prof Giorgio Pompa) presso il Corso di Laurea Specialistico in Odontoiatria e Protesi Dentaria dellrsquo Universitagrave degli Studi di Roma Sapienza

Docente del Master di II livello in ldquoImplantoprotesi in Odontostomatologiardquo

Direttore Prof Manlio Quaranta

presso

il Dipto di Scienze Odontostomatologiche dellrsquo Universitagrave di Roma ldquoSapienzardquo

Il 04 03 2010 consegue il titolo di Dottore di Ricerca in Malattie Odontostomatologiche presso il Dipartimanto di Scienze Odontostomatologiche della Ideg Facoltagrave di Medicina e Chirurgia dellrsquoUniversitagrave degli Studi di Roma ldquoSapienzardquo con una tesi dal titolo

ldquo VALUTAZIONE SPERIMENTALE CLINICO RADIOLOGICA SULLrsquoUSO DEGLI IMPIANTI A RIPARAZIONE OSSEA PRIMARIA NEL CARICO

IMMEDIATO POST ESTRATTIVOrdquo

Il 28052010 riceve il titolo di

Professore a contratto

per lrsquoinsegnamento di

ldquoImplantoprotesi in Odontostomatologiardquo

al Master di II livello presso il Dipto di Scienze Odontostomatologiche della Ideg

Facoltagrave di Medicina e Chirurgia Universitagrave di Roma ldquoSapienzardquo

Autore di numerose pubblicazioni in campo scientifico nazionale e internazionale

87th General Session amp Exhibition of the IADRMiami Florida - April 1-4 2009

CLINICAL EVALUATION OF OSSEOINTEGRATION OF IMPLANTS PLACED IN GRAFTED BONEI VOZZA S ROSSI L PICCOLI and M QUARANTA

Dental School Prosthodontics Department ldquoLa Sapienzardquo University Rome Italy

INTRODUCTION

Primary Bone Regeneration (PBR) is a mechanism of natural bone healing leading to consolidation of two bone segments in 6 weeks In Implant-Prosthodontics

PBR implants let the patient have quicker prosthetic rehabilitation also in case of severe bone atrophy and after guided bone regeneration In fact with PBR implantsitrsquos possible to load them just after 45 days from implants insertion This depends on primary intention bone healing with direct formation of bone tissue close incontact with implants and without interposition of connective tissue The aim of this study was to evaluate osseointegration in early loaded PBR implants insertedtogether with bone grafts in atrophic alveolar ridges

REFERENCES

Cornelini R Barone A Covani U Connective tissue grafts in postextraction implants with immediate restoration a prospective controlled clinical study Pract Proced Aesthet Dent 2008 Jul20(6)337-43

Esposito M Grusovin MG Achille H Coulthard P Worthington HV Interventions for replacing missing teeth different times for loading dental implants Cochrane Database Syst Rev 2009 Jan 21(1)CD003878

Friberg B Raghoebar GM et al A 5-year prospective multicenter study on 1-stage smooth-surface Branemark System implants with early loading in edentulous mandibles Int J Oral Maxillofac Implants 2008 May23(3)481-6

Lai HC Zhang ZY Zhuang LF Wang F Liu X Pu YP Early loading of ITI implants supporting maxillary fixed full-arch prostheses Clin Oral Implants Res 2008 Nov19(11)1129-34

Malchiodi L Quaranta A Scarano A Quaranta M Jaw reconstruction with grafted autologous bone early insertion of osseointegrated implants and early prosthetic loading J Oral Maxillofac Surg 2006 Aug64(8)1190-8

Mannai C Early implant loading in severely resorbed maxilla using xenograft autograft and platelet-rich plasma in 97 patients J Oral Maxillofac Surg 2006 Sep64(9)1420-6

Piattelli A Corigliano M Scarano A Quaranta M Bone reactions to early occlusal loading of two-stage titanium plasma-sprayed implants a pilot study in monkeys Int J Periodontics Restorative Dent 1997 Apr17(2)162-9

Sennerby L Gottlow J Clinical outcome of immediatelyearly loading of dental implants A literature review of recent controlled prospective clinical studies Aust Dent J 2008 Jun53 Suppl 1S82-8

MATERIALS AND METHODSIn our Prosthodontics Dept Sapienza University of Rome from November 2004 to October 2007 we selected 24 patients (both sexes 42 years mean age wellhealthy no smokers) having maxillary and mandibular partial atrophic alveolar ridges and asking for implant supported prostheses We inserted 78 rot ormer PBRimplants (TMIreg Pressing Dental San Marino Italy) together with a bone graft material (BioOss Geistlich) Minimum implant diameter was 375mm and minimumlength was 105mm The primary implant stability was estimated by RFA When the ISQ resulted ge 57 value in the 2nd stage surgery they were early loaded (15months from surgery) The ISQ values were subsequently estimated every month until the 6th month then at 9 and 12 months The endoral X-rays have beenexecuted to 0 2 6 9 and 12 months

RESULTSIn the 2nd stage surgery a complete bone defect filling was observed in all the cases except one that was characterized by partial bone defect filling (greater than50 and without flap dehiscence) The most significant ISQ values increase was observed in the first 2 months a further ISQ value increasing was observed until the3rd-4th month and successively the ISQ values levelled on constant shares At the end of the second month just 6 implants (77) of 5 different patients didnrsquot show57 ISQ value Among these implants 2 showed clinical mobility (M) in early time (third and fourth month) and they were removed and indicated like failures Theendoral X-ray didnrsquot show any change of the marginal bone level Clinical and X-ray results analized with T-Student test were statistically significant (Plt0005)

CONCLUSIONSThe timing of bone tissue healing around TMI implants overlap timing of a simple fracture of the jaw bones These results showed as early loading of PBR implants

inserted together bone grafts seems to be a valid technique to restore atrophic alveolar ridges shortening healing time and having quicker clinical case resolution

689

87th General Session amp Exhibition of the IADRMiami Florida - April 1-4 2009

CLINICAL AND HISTOLOGICAL EVALUATION OF ATROPHIC MAXILLARY RIDGES IMPLANT REHABILITATIONI VOZZA S ROSSI AM CARPIO E NICOLINI and G POMPA

Dental School Prosthodontics Department ldquoLa Sapienzardquo University Rome Italy

INTRODUCTION

The latest and new indications about implant surgery and the constant introduction on the market of new components and methodologies go hand in handwith the ever-increasing demand from our patients for a quicker and quicker functional rehabilitation Primary Bone Regeneration (PBR) is a mechanism ofnatural bone healing leading to consolidation of two bone segments in 6 weeks In Implant-Prosthodontics PBR implants let the patient have quickerprosthetic rehabilitation also in case of severe bone atrophy and after guided bone regeneration In fact with PBR implants itrsquos possible to load them justafter 45 days from implants insertion This depends on primary intention bone healing with direct formation of bone tissue close in contact with implants andwithout interposition of connective tissue The aim of this study was to evaluate early loading of PBR (Primary Bone Regeneration) implants insertedtogether with bone grafts in atrophic maxillary ridges

REFERENCES

Attard NJ Zarb GA Immediate and early implant loading protocols a review of clinical studies J Prosthet Dent 2005 Sep 94 (3) 242-58

Brochu JF Anderson JD Zarb GA The influence of early loading on bony crest height and stability a pilot study Int J Prosthodont 2005 Nov-Dec 18 (6) 506-12

Cornelini R Barone A Covani U Connective tissue grafts in postextraction implants with immediate restoration a prospective controlled clinical study Pract Proced Aesthet Dent 2008 Jul20(6)337-43

Esposito M Grusovin MG Achille H Coulthard P Worthington HV Interventions for replacing missing teeth different times for loading dental implants Cochrane Database Syst Rev 2009 Jan 21(1)CD003878

Friberg B Raghoebar GM A 5-year prospective multicenter study on 1-stage smooth-surface Branemark System implants with early loading in edentulous mandibles Int J Oral Maxillofac Implants 2008 May-Jun23(3)481-6

Malchiodi L Quaranta A Scarano A Quaranta M Jaw reconstruction with grafted autologous bone early insertion of osseointegrated implants and early prosthetic loading J Oral Maxillofac Surg 2006 Aug64(8)1190-8

Mannai C Early implant loading in severely resorbed maxilla using xenograft autograft and platelet-rich plasma in 97 patients J Oral Maxillofac Surg 2006 Sep64(9)1420-6

Lai HC Zhang ZY Zhuang LF Wang F Liu X Pu YP Early loading of ITI implants supporting maxillary fixed full-arch prostheses Clin Oral Implants Res 2008 Nov19(11)1129-34

Piattelli A Corigliano M Scarano A Quaranta M Bone reactions to early occlusal loading of two-stage titanium plasma-sprayed implants a pilot study in monkeys Int J Periodontics Restorative Dent 1997 Apr17(2)162-9

Sennerby L Gottlow J Clinical outcome of immediatelyearly loading of dental implants A literature review of recent controlled prospective clinical studies Aust Dent J 2008 Jun53 Suppl 1S82-8

MATERIALS AND METHODSIn our Prosthodontics Dept Sapienza University of Rome from November 2004 to June 2007 a sinus lifting was performed in 8 patients (56 years mean agemale gender initial bone height of 15 -2 mm and bone width of 5 mm) asking for a fixed implant-supported rehabilitation They signed an informed consentIn every patient 2root former PBR implants (TMIreg Pressing Dental San Marino Italy) having 325 diameter and 105mm length were inserted together witha bone graft material (Physiograftreg Ghimas) 25 months after maxillary sinus augmentation one of the implants was retrieved and processed forundecalcified histology while the other one was loaded The endoral X-rays have been executed to 0 2 6 9 and 12 months

RESULTSFrom the histomorphometric analysis the graft material residuals accounted for the 4698 of the bioptical volume marrow spaces for the 1876 and bonefor the 3287 (new bone 2262 native bone 1025) Well-mineralized regenerated bone with lamellar parallel-fibred structure and Haversian systemssurrounded the residual graft material particles The measured BIC amounted to 1694 No connective tissue was observed at the implant boundary surfaceFrom clinical point of view there was no implant failure at the 2nd stage neither mobility nor bleeding on probing The endoral X-rays showed a completebone defect filling and no change of the marginal bone level was observed Clinical and X-ray results analized with T-Student test were statistically significant

(Plt0005) CONCLUSIONSThese results showed as early loading of PBR implants inserted together with bone grafts appears to be suitable for maxillary sinus floor augmentation alsoin critical condition as minimal vertical bone height and shorter healing time

3389

Objectives The aim of this study was to obtain immediate bone reparation in only 6 wks and to predict primary bone apposition

without intermediate growth of the connective tissue

Methods We inserted 128 PBR (Primary Bone Reparation) implants (TMIreg Pressing Dental RSM) into 42 patients of both

genders aged between 29 and 68 yrs After 45 days 25 implants were removed from their sites carefully chosen so as not

to endanger either the final prosthesis plan or the patients health The removed samples were embedded in resin (Tecnovit

Kulzer) histologically prepared (EXAKT) and stained with hematoxylin eosin and methylene blue The same samples

were then examined histologically under an optical microscope (Zeiss and Leitz) at 50-100-200-400X

86th General Session and Exibition of the IADR ndash Metro Toronto Convention Centre Canada

Histologic evaluation of a PBR implant system study in manM CORIGLIANO1 S ROSSI2 AM CARPIO2 and S DI CARLO2

1International Academy of Implantoprosthesis and Osteoconnection Rome Italy 2University

of Rome Sapienza Italy

1 Schenk RK Histologie der Primarien Knocheilung Verh Dtsch ges pathol 1974 54 8-12

2 Corigliano M Vrespa G DrsquoAddona A Casolo F Impianto a guarigione primaria Dental Cadmos 1994 11 60-72

3 Piattelli A Paolantonio M Corigliano M Scarano A Immediate loading of titanium plasma-sprayed screw-shaped implants in man a clinical and histological report of two cases J Periodontol 199768591-

597

3 Corigliano M Barlattani A Gargari M Ottria L Andreana S La riparazione ossea primaria in implantoprotesi possibilitagrave tecnica ed applicazioni Quint Int 2002 910 359-370

4 Cooper LF Rahman A Moriarty J Chaffee N Sacco D Immediate mandibular rehabilitation with endosseous implants simultaneous extraction implant placement and loadingInt J Oral Maxillofac

Implants 200217(4)517-25

5 Gherlone E Albano F Vrespa G Falegatti G Capuano A Carico immediato su impianti post estrattivi immediati Implantologia 2004125-37

6 Forabosco A et al Impianti postestrattivi a carico immediato Doctor Os 200617(1)188-190

6

TMI reg Implant System is composed by

Fig1 Pilot Drill

Fig2 Osteotom ldquo UNICArdquo

Fig3 Implant

2

Results The quantity and the quality of the bone observed histologically

in connection with the radicular titanium prostheses following PBR

registered complete growth The BIC (Bone Implant Contact) measured

all around the removed implants averaged 85 Further there were no

necrotic zones associated with the resorption or substitution with

connective fibrous tissue

Conclusions Our histologic analysis demonstrates that the PBR

implant system is without doubt reliable Actually it permits a

great deal of bone to support the progressive load of dental

prostheses

2

Histological images coloured

with hematoxylineosin and

methilene blue

Surgycal phases

1 Drilling

2 Osteotomy with ldquoUNICArdquo

3 Radicular prostheses

insert

85th General Session amp Exhibition of the IADRNew Orleans 21-24 March 2007

EARLY LOADED IMPLANT SUPPORTED OVERDENTURE 3-YEAR FOLLOW-UP EVALUATIONS ROSSI I VOZZA A GIOVANNETTI MP BASILE S DI CARLO

Dental School Prosthodontics Department ldquoLa Sapienzardquo University Rome Italy

INTRODUCTION

Primary Bone Reparation PBR is a mechanism of natural bone healing determining consolidation of two bone segments in 6 weeks In Implantology PBR implantsconsent to patient having prosthetic rehabilitation briefly because it is possible to load them just in 45 days form fixture insertion This is possible thanking to firstintention bone healing with direct formation of bone tissue in contact with implant and without interposition of connective tissue Times of tissue reparationaround implants are superimposable to times of a simple fracture of maxilla The aim of this study was to evaluate perimplant marginal bone level on early loadedimplants supporting overdenture

REFERENCES

Attard NJ Zarb GA Immediate and early implant loading protocols a literature review of clinical studies J Prosthet Dent 200594(3)242-58

Brochu JF Anderson JD Zarb GA The influence of early loading on bony crest height and stability a pilot study Int J Prosthodont 200518(6)506-12

Chiapasco M Early and immediate restoration and loading of implants in completely edentulous patients Int J Oral Maxillofac Implants 200419 Suppl76-91

Mericske-Stern R Oetterli M Kiener P Mericske E A follow-up study of maxillary implants supporting an overdenture clinical and radiographic results Int J Oral Maxillofac Implants 200217(5)678-86

Misch CE Degidi M 5-year prospective study of immediateearly loading of fixed prostheses in completely edentulous jaw with a bone quality-based implant system Clin Implant Dent Relat Res 20035(1)17-28

Payne AG Tawse-Smith A Thomson WM Duncan WD Kumara R One-stage surgery and early loading of three implants for maxillary overdenture a 1-year report Clin Implant Dent Relat Res 20046(2)61-74

Raghoebar GM Friberg B Grunert I Hobkirk JA Tepper G Wendelhag I 3-year prospective multicenter study on one-stage implant surgery and early loading in the edentulous mandible Clin Implant Dent Relat Res 20035(1)39-46

Raghoebar GM Schoen P Meijer HJ Stellingsma K Vissink A Early loading of endosseous implants in the augmented maxilla a 1-year prospective study Clin Oral Implants Res 200314(6)697-702

MATERIALS AND METHODSIn our Prosthodontics Depratment La Sapienza University of Rome from May 2001 to December November 2003 we selected 30 patients (both sexes 49 yearsmean age no smokers) having maxillary total edentulism and asking for fixed prosthetic rehabilitation We inserted 128 root former implants (TMI PressingDental San Marino) they were early loaded after 45 days Minimum diameter was 42mm and minimum length was 13mm Before cementation of each finalrestoration we executed a periapical X-ray using a digital X-ray system (Den Optix Gendex Dentsply Int) The X-ray controls were executed after 1-3-6-9-12months and then yearly

RESULTSMarginal bone levels were evaluated by 2 different operators using a computerised measure system (Vix-win 2000 Gendex Dentsply Int) During the first yearthere was 028mm mean bone loss while during the next two years it was 017mm according to Albrektsson and Zarb implant success criteria (lt1mm during thefirst year and lt02mm during next years) X-ray results analized with T-Student test were statistically significant (Plt0005)

CONCLUSIONSParameters for the valuation of Implantology success have to be established before discussing about obtained results by this experimentation On the basis ofthis osseointegration definition clinical studies have to be purposed to survey the implant stability under functional loading In this order itrsquos necessary thatduring periodic controls implant mobility has to be evaluated and radiographic examinations have to be executed in a reproducible way for determining the stateof perimplant bone tissue health The implant success is evaluated on the following criteria by Albrektsson and Zarb 1) the not splinted implant has to be clinicallyimmovable 2) on the X-ray no perimplant radiotranslucency marks have to be present 3) vertical bone loss has to be lower than 1mm during the first year ofloading and lower than 02mm yearly in the following years 4) each implant has to be without marks or persistent andor not reversible symptoms for examplepain infections neuropathies paresthesis or penetration into the mandibular canal 5)prosthetic restoration has to satisfy function and aesthetics On thesepreliminary remarks in the anterior upper and lower sectors it should occur a success rate of 90 and 85 on long time respectively after 5 and 10 years in theposterior sectors these percentages have to be about 85 after 5 years and 80 after 10 years The obtained results from this experimentation are encouragingfully respecting implant success criteria by Albrektsson and Zarb These results showed as early loaded implants supporting overdenture are clinically andradiographically well osseointegrated

516

Introduction ndash It has been clearly proved by Ludwig through Fourierrsquos analysis [ Ludwig1993] that ultraweak signals are easly recognazed compared with the background noise if they present a patternthe signals the living matter is able to recognized among a variety of interferential signals are highly complex that is they are made up of different frequency bands Infact the complex signal reaches the biological system as a repetition of weak signals but connected among them in a fixed pattern and it is the

repetition of this pattern that distinguish the ldquotrue signalrdquo from the background noise The action of the CMF identifies as the sum of the effects of superimposed continous and pulsed magnetic fields on biological systemsOn the bone tissue is possible to obtain a neo-osteomorphogenesis increasing the gene expression of the morphogenetic proteins

and modulating the osteoclastogenetic proteins action The same results we can obtain on soft tissue The target of our clinical trial ldquoin vivordquo can demonstrate the effects of Combined Magnetic Field on the bone tissue in oral implantology

Methods 458 patients of both genders aged between 35 and 72 yrs underwent implant surgery associated with GBR according to the protocol of the PBR implant system 1024

fixtures were inserted by means of the TMIreg implant system (Pressing Dental RSM) The MET and CMF (MFI Italy) were applied to all patients for 74 days

Osteogenesis was radiologically controlled after 30 60 90 and 120 days All implants were loaded in 120 days

86th General Session and Exibition of the IADR ndash Metro Toronto Convention Centre Canada

Osteomorphogenesis biostimulated by CMF Combined Magnetic Fields M Corigliano1 S Rossi2 F Crescentini2 A Giovanetti2 S Di Carlo2

1International Academy of Implantoprosthesis and Osteoconnection Rome Italy 2 University of Rome Sapienza Italy

Induttori della TME

applicati

CMF-OS amp BR (1) TME (2) MFI Production

1

2

Stimulated morphogenetic proteins gene expression

and modulation of osteoclastogenesis by CMF induction

FGF-2 FGFai AngiopoietinTrombopoietin EGFConnexin 43 Cox-1 e Cox-2 BMP-2 BMP-4 c-myc e c-fosG-proteinCollagen I osteocalcin

Signal Molecules Erk frac12CREBIRS-1eNOS Cytokine IL1 TNFαTNFβTGkαTGFβPDGFIGF-1IGF-

2FGF Osteoclastogenesis Modulators OPGRank RANKL

M-CSFPGE2 EnzymesCytocrome-OssidaseNaK-ATPase hsp70

ornithine decarboxilase adinylate-cyclase protein kinase C

Densification Proteins and ions Osteocalcin Procollagenionized calcium ALPEstrogen-receptor system

Proteoglycans Collagen IIITP1 TPIII

Results All those who underwent implant therapy with GBR and were treated with the combination of MET and CMF showed complete mineralization in a shorter period of time than that commonly reported in these

cases

Conclusions The combined use of MET and CMF together with the PBR implant system can ameliorate and strengthen the physiological mechanisms of bone reparation

Materials CMF-OS ampBR Inductor of CMF multifrequential and presequential with continous magnetic fields Frequency from 1 to 80Hz Amplitude from 1

a 100μT and field amplifierconcentrator TME inductor of bifrequential fieldAmplitude from 5 a 50G for domiciliary use

Induction Method 6 inductions with CMF every 3 days for 12 mindie and TME domiciliary 30min X 2die X 45 days( inductors MFI Italy)

1 2 3

Soft Tissues unsuccessfull gengivoplasty Fase1 date 11042007 (2)date 11182007 (3)12062007 CMF treated 6 X 12 min induction sequenced every 3days

Ludwig W Magneitc Field Therapy In Alternative Medicine Future Medicine Publishing Washington (1993) McLeod BR Liboff AR Dynamic characteristics of membrane ions in multifield configurations of low-frequency

electromagnetic radiationBioelectromagnetics 19867(2)177-89

Blank M Goodman R Electromagnetic fields may act directly on DNADepartment of Physiology Columbia University New York New York 10032 USA mb32columbiaedu J Cell Biochem 1999 Dec 175(3)369-74

Fig1 Dental-Scan Fig2 Implants Fig3 RX results After 45 days

CMF-TME therapy 1 2 3

Il 200605 consegue Borsa di Studio biennale presso LrsquoIstituto di Clinica Odontoiatrica dellrsquoUniversitagrave degli Studi di Roma ldquoLa Sapienzardquo per lo svolgimento di ldquoIndagine clinica sullrsquouso degli impianti TMIreg in Implantoprotesirdquo

Nellrsquo Anno Accademico 200607 egrave vincitore del concorso per il Dottorato di Ricerca in Malattie Odontostomatologiche XXII ciclo e svolge funzioni di Dottorando di Ricerca presso il Dipto di Scienze Odontostomatologiche Ideg Facoltagrave di Medicina e Chirurgia dellrsquo Universitagrave degli Studi di Roma ldquoSapienzardquo

Il 060409 consegue una seconda borsa di studio triennale presso il Dipto di Scienze Odontostomatologiche dellrsquoUniversitagrave degli Studi di Roma ldquoLa Sapienzardquo per lo svolgimento di una ricerca sullrsquouso degli impianti TMIreg con il protocollo clinico del carico immediato

Incaricato dallrsquo Anno Accademico 200304 dellrsquoinsegnamento di ldquoTecnologie Protesiche e di Laboratoriordquo (Titolare Prof Giorgio Pompa) presso il Corso di Laurea Specialistico in Odontoiatria e Protesi Dentaria dellrsquo Universitagrave degli Studi di Roma Sapienza

Docente del Master di II livello in ldquoImplantoprotesi in Odontostomatologiardquo

Direttore Prof Manlio Quaranta

presso

il Dipto di Scienze Odontostomatologiche dellrsquo Universitagrave di Roma ldquoSapienzardquo

Il 04 03 2010 consegue il titolo di Dottore di Ricerca in Malattie Odontostomatologiche presso il Dipartimanto di Scienze Odontostomatologiche della Ideg Facoltagrave di Medicina e Chirurgia dellrsquoUniversitagrave degli Studi di Roma ldquoSapienzardquo con una tesi dal titolo

ldquo VALUTAZIONE SPERIMENTALE CLINICO RADIOLOGICA SULLrsquoUSO DEGLI IMPIANTI A RIPARAZIONE OSSEA PRIMARIA NEL CARICO

IMMEDIATO POST ESTRATTIVOrdquo

Il 28052010 riceve il titolo di

Professore a contratto

per lrsquoinsegnamento di

ldquoImplantoprotesi in Odontostomatologiardquo

al Master di II livello presso il Dipto di Scienze Odontostomatologiche della Ideg

Facoltagrave di Medicina e Chirurgia Universitagrave di Roma ldquoSapienzardquo

Autore di numerose pubblicazioni in campo scientifico nazionale e internazionale

87th General Session amp Exhibition of the IADRMiami Florida - April 1-4 2009

CLINICAL EVALUATION OF OSSEOINTEGRATION OF IMPLANTS PLACED IN GRAFTED BONEI VOZZA S ROSSI L PICCOLI and M QUARANTA

Dental School Prosthodontics Department ldquoLa Sapienzardquo University Rome Italy

INTRODUCTION

Primary Bone Regeneration (PBR) is a mechanism of natural bone healing leading to consolidation of two bone segments in 6 weeks In Implant-Prosthodontics

PBR implants let the patient have quicker prosthetic rehabilitation also in case of severe bone atrophy and after guided bone regeneration In fact with PBR implantsitrsquos possible to load them just after 45 days from implants insertion This depends on primary intention bone healing with direct formation of bone tissue close incontact with implants and without interposition of connective tissue The aim of this study was to evaluate osseointegration in early loaded PBR implants insertedtogether with bone grafts in atrophic alveolar ridges

REFERENCES

Cornelini R Barone A Covani U Connective tissue grafts in postextraction implants with immediate restoration a prospective controlled clinical study Pract Proced Aesthet Dent 2008 Jul20(6)337-43

Esposito M Grusovin MG Achille H Coulthard P Worthington HV Interventions for replacing missing teeth different times for loading dental implants Cochrane Database Syst Rev 2009 Jan 21(1)CD003878

Friberg B Raghoebar GM et al A 5-year prospective multicenter study on 1-stage smooth-surface Branemark System implants with early loading in edentulous mandibles Int J Oral Maxillofac Implants 2008 May23(3)481-6

Lai HC Zhang ZY Zhuang LF Wang F Liu X Pu YP Early loading of ITI implants supporting maxillary fixed full-arch prostheses Clin Oral Implants Res 2008 Nov19(11)1129-34

Malchiodi L Quaranta A Scarano A Quaranta M Jaw reconstruction with grafted autologous bone early insertion of osseointegrated implants and early prosthetic loading J Oral Maxillofac Surg 2006 Aug64(8)1190-8

Mannai C Early implant loading in severely resorbed maxilla using xenograft autograft and platelet-rich plasma in 97 patients J Oral Maxillofac Surg 2006 Sep64(9)1420-6

Piattelli A Corigliano M Scarano A Quaranta M Bone reactions to early occlusal loading of two-stage titanium plasma-sprayed implants a pilot study in monkeys Int J Periodontics Restorative Dent 1997 Apr17(2)162-9

Sennerby L Gottlow J Clinical outcome of immediatelyearly loading of dental implants A literature review of recent controlled prospective clinical studies Aust Dent J 2008 Jun53 Suppl 1S82-8

MATERIALS AND METHODSIn our Prosthodontics Dept Sapienza University of Rome from November 2004 to October 2007 we selected 24 patients (both sexes 42 years mean age wellhealthy no smokers) having maxillary and mandibular partial atrophic alveolar ridges and asking for implant supported prostheses We inserted 78 rot ormer PBRimplants (TMIreg Pressing Dental San Marino Italy) together with a bone graft material (BioOss Geistlich) Minimum implant diameter was 375mm and minimumlength was 105mm The primary implant stability was estimated by RFA When the ISQ resulted ge 57 value in the 2nd stage surgery they were early loaded (15months from surgery) The ISQ values were subsequently estimated every month until the 6th month then at 9 and 12 months The endoral X-rays have beenexecuted to 0 2 6 9 and 12 months

RESULTSIn the 2nd stage surgery a complete bone defect filling was observed in all the cases except one that was characterized by partial bone defect filling (greater than50 and without flap dehiscence) The most significant ISQ values increase was observed in the first 2 months a further ISQ value increasing was observed until the3rd-4th month and successively the ISQ values levelled on constant shares At the end of the second month just 6 implants (77) of 5 different patients didnrsquot show57 ISQ value Among these implants 2 showed clinical mobility (M) in early time (third and fourth month) and they were removed and indicated like failures Theendoral X-ray didnrsquot show any change of the marginal bone level Clinical and X-ray results analized with T-Student test were statistically significant (Plt0005)

CONCLUSIONSThe timing of bone tissue healing around TMI implants overlap timing of a simple fracture of the jaw bones These results showed as early loading of PBR implants

inserted together bone grafts seems to be a valid technique to restore atrophic alveolar ridges shortening healing time and having quicker clinical case resolution

689

87th General Session amp Exhibition of the IADRMiami Florida - April 1-4 2009

CLINICAL AND HISTOLOGICAL EVALUATION OF ATROPHIC MAXILLARY RIDGES IMPLANT REHABILITATIONI VOZZA S ROSSI AM CARPIO E NICOLINI and G POMPA

Dental School Prosthodontics Department ldquoLa Sapienzardquo University Rome Italy

INTRODUCTION

The latest and new indications about implant surgery and the constant introduction on the market of new components and methodologies go hand in handwith the ever-increasing demand from our patients for a quicker and quicker functional rehabilitation Primary Bone Regeneration (PBR) is a mechanism ofnatural bone healing leading to consolidation of two bone segments in 6 weeks In Implant-Prosthodontics PBR implants let the patient have quickerprosthetic rehabilitation also in case of severe bone atrophy and after guided bone regeneration In fact with PBR implants itrsquos possible to load them justafter 45 days from implants insertion This depends on primary intention bone healing with direct formation of bone tissue close in contact with implants andwithout interposition of connective tissue The aim of this study was to evaluate early loading of PBR (Primary Bone Regeneration) implants insertedtogether with bone grafts in atrophic maxillary ridges

REFERENCES

Attard NJ Zarb GA Immediate and early implant loading protocols a review of clinical studies J Prosthet Dent 2005 Sep 94 (3) 242-58

Brochu JF Anderson JD Zarb GA The influence of early loading on bony crest height and stability a pilot study Int J Prosthodont 2005 Nov-Dec 18 (6) 506-12

Cornelini R Barone A Covani U Connective tissue grafts in postextraction implants with immediate restoration a prospective controlled clinical study Pract Proced Aesthet Dent 2008 Jul20(6)337-43

Esposito M Grusovin MG Achille H Coulthard P Worthington HV Interventions for replacing missing teeth different times for loading dental implants Cochrane Database Syst Rev 2009 Jan 21(1)CD003878

Friberg B Raghoebar GM A 5-year prospective multicenter study on 1-stage smooth-surface Branemark System implants with early loading in edentulous mandibles Int J Oral Maxillofac Implants 2008 May-Jun23(3)481-6

Malchiodi L Quaranta A Scarano A Quaranta M Jaw reconstruction with grafted autologous bone early insertion of osseointegrated implants and early prosthetic loading J Oral Maxillofac Surg 2006 Aug64(8)1190-8

Mannai C Early implant loading in severely resorbed maxilla using xenograft autograft and platelet-rich plasma in 97 patients J Oral Maxillofac Surg 2006 Sep64(9)1420-6

Lai HC Zhang ZY Zhuang LF Wang F Liu X Pu YP Early loading of ITI implants supporting maxillary fixed full-arch prostheses Clin Oral Implants Res 2008 Nov19(11)1129-34

Piattelli A Corigliano M Scarano A Quaranta M Bone reactions to early occlusal loading of two-stage titanium plasma-sprayed implants a pilot study in monkeys Int J Periodontics Restorative Dent 1997 Apr17(2)162-9

Sennerby L Gottlow J Clinical outcome of immediatelyearly loading of dental implants A literature review of recent controlled prospective clinical studies Aust Dent J 2008 Jun53 Suppl 1S82-8

MATERIALS AND METHODSIn our Prosthodontics Dept Sapienza University of Rome from November 2004 to June 2007 a sinus lifting was performed in 8 patients (56 years mean agemale gender initial bone height of 15 -2 mm and bone width of 5 mm) asking for a fixed implant-supported rehabilitation They signed an informed consentIn every patient 2root former PBR implants (TMIreg Pressing Dental San Marino Italy) having 325 diameter and 105mm length were inserted together witha bone graft material (Physiograftreg Ghimas) 25 months after maxillary sinus augmentation one of the implants was retrieved and processed forundecalcified histology while the other one was loaded The endoral X-rays have been executed to 0 2 6 9 and 12 months

RESULTSFrom the histomorphometric analysis the graft material residuals accounted for the 4698 of the bioptical volume marrow spaces for the 1876 and bonefor the 3287 (new bone 2262 native bone 1025) Well-mineralized regenerated bone with lamellar parallel-fibred structure and Haversian systemssurrounded the residual graft material particles The measured BIC amounted to 1694 No connective tissue was observed at the implant boundary surfaceFrom clinical point of view there was no implant failure at the 2nd stage neither mobility nor bleeding on probing The endoral X-rays showed a completebone defect filling and no change of the marginal bone level was observed Clinical and X-ray results analized with T-Student test were statistically significant

(Plt0005) CONCLUSIONSThese results showed as early loading of PBR implants inserted together with bone grafts appears to be suitable for maxillary sinus floor augmentation alsoin critical condition as minimal vertical bone height and shorter healing time

3389

Objectives The aim of this study was to obtain immediate bone reparation in only 6 wks and to predict primary bone apposition

without intermediate growth of the connective tissue

Methods We inserted 128 PBR (Primary Bone Reparation) implants (TMIreg Pressing Dental RSM) into 42 patients of both

genders aged between 29 and 68 yrs After 45 days 25 implants were removed from their sites carefully chosen so as not

to endanger either the final prosthesis plan or the patients health The removed samples were embedded in resin (Tecnovit

Kulzer) histologically prepared (EXAKT) and stained with hematoxylin eosin and methylene blue The same samples

were then examined histologically under an optical microscope (Zeiss and Leitz) at 50-100-200-400X

86th General Session and Exibition of the IADR ndash Metro Toronto Convention Centre Canada

Histologic evaluation of a PBR implant system study in manM CORIGLIANO1 S ROSSI2 AM CARPIO2 and S DI CARLO2

1International Academy of Implantoprosthesis and Osteoconnection Rome Italy 2University

of Rome Sapienza Italy

1 Schenk RK Histologie der Primarien Knocheilung Verh Dtsch ges pathol 1974 54 8-12

2 Corigliano M Vrespa G DrsquoAddona A Casolo F Impianto a guarigione primaria Dental Cadmos 1994 11 60-72

3 Piattelli A Paolantonio M Corigliano M Scarano A Immediate loading of titanium plasma-sprayed screw-shaped implants in man a clinical and histological report of two cases J Periodontol 199768591-

597

3 Corigliano M Barlattani A Gargari M Ottria L Andreana S La riparazione ossea primaria in implantoprotesi possibilitagrave tecnica ed applicazioni Quint Int 2002 910 359-370

4 Cooper LF Rahman A Moriarty J Chaffee N Sacco D Immediate mandibular rehabilitation with endosseous implants simultaneous extraction implant placement and loadingInt J Oral Maxillofac

Implants 200217(4)517-25

5 Gherlone E Albano F Vrespa G Falegatti G Capuano A Carico immediato su impianti post estrattivi immediati Implantologia 2004125-37

6 Forabosco A et al Impianti postestrattivi a carico immediato Doctor Os 200617(1)188-190

6

TMI reg Implant System is composed by

Fig1 Pilot Drill

Fig2 Osteotom ldquo UNICArdquo

Fig3 Implant

2

Results The quantity and the quality of the bone observed histologically

in connection with the radicular titanium prostheses following PBR

registered complete growth The BIC (Bone Implant Contact) measured

all around the removed implants averaged 85 Further there were no

necrotic zones associated with the resorption or substitution with

connective fibrous tissue

Conclusions Our histologic analysis demonstrates that the PBR

implant system is without doubt reliable Actually it permits a

great deal of bone to support the progressive load of dental

prostheses

2

Histological images coloured

with hematoxylineosin and

methilene blue

Surgycal phases

1 Drilling

2 Osteotomy with ldquoUNICArdquo

3 Radicular prostheses

insert

85th General Session amp Exhibition of the IADRNew Orleans 21-24 March 2007

EARLY LOADED IMPLANT SUPPORTED OVERDENTURE 3-YEAR FOLLOW-UP EVALUATIONS ROSSI I VOZZA A GIOVANNETTI MP BASILE S DI CARLO

Dental School Prosthodontics Department ldquoLa Sapienzardquo University Rome Italy

INTRODUCTION

Primary Bone Reparation PBR is a mechanism of natural bone healing determining consolidation of two bone segments in 6 weeks In Implantology PBR implantsconsent to patient having prosthetic rehabilitation briefly because it is possible to load them just in 45 days form fixture insertion This is possible thanking to firstintention bone healing with direct formation of bone tissue in contact with implant and without interposition of connective tissue Times of tissue reparationaround implants are superimposable to times of a simple fracture of maxilla The aim of this study was to evaluate perimplant marginal bone level on early loadedimplants supporting overdenture

REFERENCES

Attard NJ Zarb GA Immediate and early implant loading protocols a literature review of clinical studies J Prosthet Dent 200594(3)242-58

Brochu JF Anderson JD Zarb GA The influence of early loading on bony crest height and stability a pilot study Int J Prosthodont 200518(6)506-12

Chiapasco M Early and immediate restoration and loading of implants in completely edentulous patients Int J Oral Maxillofac Implants 200419 Suppl76-91

Mericske-Stern R Oetterli M Kiener P Mericske E A follow-up study of maxillary implants supporting an overdenture clinical and radiographic results Int J Oral Maxillofac Implants 200217(5)678-86

Misch CE Degidi M 5-year prospective study of immediateearly loading of fixed prostheses in completely edentulous jaw with a bone quality-based implant system Clin Implant Dent Relat Res 20035(1)17-28

Payne AG Tawse-Smith A Thomson WM Duncan WD Kumara R One-stage surgery and early loading of three implants for maxillary overdenture a 1-year report Clin Implant Dent Relat Res 20046(2)61-74

Raghoebar GM Friberg B Grunert I Hobkirk JA Tepper G Wendelhag I 3-year prospective multicenter study on one-stage implant surgery and early loading in the edentulous mandible Clin Implant Dent Relat Res 20035(1)39-46

Raghoebar GM Schoen P Meijer HJ Stellingsma K Vissink A Early loading of endosseous implants in the augmented maxilla a 1-year prospective study Clin Oral Implants Res 200314(6)697-702

MATERIALS AND METHODSIn our Prosthodontics Depratment La Sapienza University of Rome from May 2001 to December November 2003 we selected 30 patients (both sexes 49 yearsmean age no smokers) having maxillary total edentulism and asking for fixed prosthetic rehabilitation We inserted 128 root former implants (TMI PressingDental San Marino) they were early loaded after 45 days Minimum diameter was 42mm and minimum length was 13mm Before cementation of each finalrestoration we executed a periapical X-ray using a digital X-ray system (Den Optix Gendex Dentsply Int) The X-ray controls were executed after 1-3-6-9-12months and then yearly

RESULTSMarginal bone levels were evaluated by 2 different operators using a computerised measure system (Vix-win 2000 Gendex Dentsply Int) During the first yearthere was 028mm mean bone loss while during the next two years it was 017mm according to Albrektsson and Zarb implant success criteria (lt1mm during thefirst year and lt02mm during next years) X-ray results analized with T-Student test were statistically significant (Plt0005)

CONCLUSIONSParameters for the valuation of Implantology success have to be established before discussing about obtained results by this experimentation On the basis ofthis osseointegration definition clinical studies have to be purposed to survey the implant stability under functional loading In this order itrsquos necessary thatduring periodic controls implant mobility has to be evaluated and radiographic examinations have to be executed in a reproducible way for determining the stateof perimplant bone tissue health The implant success is evaluated on the following criteria by Albrektsson and Zarb 1) the not splinted implant has to be clinicallyimmovable 2) on the X-ray no perimplant radiotranslucency marks have to be present 3) vertical bone loss has to be lower than 1mm during the first year ofloading and lower than 02mm yearly in the following years 4) each implant has to be without marks or persistent andor not reversible symptoms for examplepain infections neuropathies paresthesis or penetration into the mandibular canal 5)prosthetic restoration has to satisfy function and aesthetics On thesepreliminary remarks in the anterior upper and lower sectors it should occur a success rate of 90 and 85 on long time respectively after 5 and 10 years in theposterior sectors these percentages have to be about 85 after 5 years and 80 after 10 years The obtained results from this experimentation are encouragingfully respecting implant success criteria by Albrektsson and Zarb These results showed as early loaded implants supporting overdenture are clinically andradiographically well osseointegrated

516

Introduction ndash It has been clearly proved by Ludwig through Fourierrsquos analysis [ Ludwig1993] that ultraweak signals are easly recognazed compared with the background noise if they present a patternthe signals the living matter is able to recognized among a variety of interferential signals are highly complex that is they are made up of different frequency bands Infact the complex signal reaches the biological system as a repetition of weak signals but connected among them in a fixed pattern and it is the

repetition of this pattern that distinguish the ldquotrue signalrdquo from the background noise The action of the CMF identifies as the sum of the effects of superimposed continous and pulsed magnetic fields on biological systemsOn the bone tissue is possible to obtain a neo-osteomorphogenesis increasing the gene expression of the morphogenetic proteins

and modulating the osteoclastogenetic proteins action The same results we can obtain on soft tissue The target of our clinical trial ldquoin vivordquo can demonstrate the effects of Combined Magnetic Field on the bone tissue in oral implantology

Methods 458 patients of both genders aged between 35 and 72 yrs underwent implant surgery associated with GBR according to the protocol of the PBR implant system 1024

fixtures were inserted by means of the TMIreg implant system (Pressing Dental RSM) The MET and CMF (MFI Italy) were applied to all patients for 74 days

Osteogenesis was radiologically controlled after 30 60 90 and 120 days All implants were loaded in 120 days

86th General Session and Exibition of the IADR ndash Metro Toronto Convention Centre Canada

Osteomorphogenesis biostimulated by CMF Combined Magnetic Fields M Corigliano1 S Rossi2 F Crescentini2 A Giovanetti2 S Di Carlo2

1International Academy of Implantoprosthesis and Osteoconnection Rome Italy 2 University of Rome Sapienza Italy

Induttori della TME

applicati

CMF-OS amp BR (1) TME (2) MFI Production

1

2

Stimulated morphogenetic proteins gene expression

and modulation of osteoclastogenesis by CMF induction

FGF-2 FGFai AngiopoietinTrombopoietin EGFConnexin 43 Cox-1 e Cox-2 BMP-2 BMP-4 c-myc e c-fosG-proteinCollagen I osteocalcin

Signal Molecules Erk frac12CREBIRS-1eNOS Cytokine IL1 TNFαTNFβTGkαTGFβPDGFIGF-1IGF-

2FGF Osteoclastogenesis Modulators OPGRank RANKL

M-CSFPGE2 EnzymesCytocrome-OssidaseNaK-ATPase hsp70

ornithine decarboxilase adinylate-cyclase protein kinase C

Densification Proteins and ions Osteocalcin Procollagenionized calcium ALPEstrogen-receptor system

Proteoglycans Collagen IIITP1 TPIII

Results All those who underwent implant therapy with GBR and were treated with the combination of MET and CMF showed complete mineralization in a shorter period of time than that commonly reported in these

cases

Conclusions The combined use of MET and CMF together with the PBR implant system can ameliorate and strengthen the physiological mechanisms of bone reparation

Materials CMF-OS ampBR Inductor of CMF multifrequential and presequential with continous magnetic fields Frequency from 1 to 80Hz Amplitude from 1

a 100μT and field amplifierconcentrator TME inductor of bifrequential fieldAmplitude from 5 a 50G for domiciliary use

Induction Method 6 inductions with CMF every 3 days for 12 mindie and TME domiciliary 30min X 2die X 45 days( inductors MFI Italy)

1 2 3

Soft Tissues unsuccessfull gengivoplasty Fase1 date 11042007 (2)date 11182007 (3)12062007 CMF treated 6 X 12 min induction sequenced every 3days

Ludwig W Magneitc Field Therapy In Alternative Medicine Future Medicine Publishing Washington (1993) McLeod BR Liboff AR Dynamic characteristics of membrane ions in multifield configurations of low-frequency

electromagnetic radiationBioelectromagnetics 19867(2)177-89

Blank M Goodman R Electromagnetic fields may act directly on DNADepartment of Physiology Columbia University New York New York 10032 USA mb32columbiaedu J Cell Biochem 1999 Dec 175(3)369-74

Fig1 Dental-Scan Fig2 Implants Fig3 RX results After 45 days

CMF-TME therapy 1 2 3

Nellrsquo Anno Accademico 200607 egrave vincitore del concorso per il Dottorato di Ricerca in Malattie Odontostomatologiche XXII ciclo e svolge funzioni di Dottorando di Ricerca presso il Dipto di Scienze Odontostomatologiche Ideg Facoltagrave di Medicina e Chirurgia dellrsquo Universitagrave degli Studi di Roma ldquoSapienzardquo

Il 060409 consegue una seconda borsa di studio triennale presso il Dipto di Scienze Odontostomatologiche dellrsquoUniversitagrave degli Studi di Roma ldquoLa Sapienzardquo per lo svolgimento di una ricerca sullrsquouso degli impianti TMIreg con il protocollo clinico del carico immediato

Incaricato dallrsquo Anno Accademico 200304 dellrsquoinsegnamento di ldquoTecnologie Protesiche e di Laboratoriordquo (Titolare Prof Giorgio Pompa) presso il Corso di Laurea Specialistico in Odontoiatria e Protesi Dentaria dellrsquo Universitagrave degli Studi di Roma Sapienza

Docente del Master di II livello in ldquoImplantoprotesi in Odontostomatologiardquo

Direttore Prof Manlio Quaranta

presso

il Dipto di Scienze Odontostomatologiche dellrsquo Universitagrave di Roma ldquoSapienzardquo

Il 04 03 2010 consegue il titolo di Dottore di Ricerca in Malattie Odontostomatologiche presso il Dipartimanto di Scienze Odontostomatologiche della Ideg Facoltagrave di Medicina e Chirurgia dellrsquoUniversitagrave degli Studi di Roma ldquoSapienzardquo con una tesi dal titolo

ldquo VALUTAZIONE SPERIMENTALE CLINICO RADIOLOGICA SULLrsquoUSO DEGLI IMPIANTI A RIPARAZIONE OSSEA PRIMARIA NEL CARICO

IMMEDIATO POST ESTRATTIVOrdquo

Il 28052010 riceve il titolo di

Professore a contratto

per lrsquoinsegnamento di

ldquoImplantoprotesi in Odontostomatologiardquo

al Master di II livello presso il Dipto di Scienze Odontostomatologiche della Ideg

Facoltagrave di Medicina e Chirurgia Universitagrave di Roma ldquoSapienzardquo

Autore di numerose pubblicazioni in campo scientifico nazionale e internazionale

87th General Session amp Exhibition of the IADRMiami Florida - April 1-4 2009

CLINICAL EVALUATION OF OSSEOINTEGRATION OF IMPLANTS PLACED IN GRAFTED BONEI VOZZA S ROSSI L PICCOLI and M QUARANTA

Dental School Prosthodontics Department ldquoLa Sapienzardquo University Rome Italy

INTRODUCTION

Primary Bone Regeneration (PBR) is a mechanism of natural bone healing leading to consolidation of two bone segments in 6 weeks In Implant-Prosthodontics

PBR implants let the patient have quicker prosthetic rehabilitation also in case of severe bone atrophy and after guided bone regeneration In fact with PBR implantsitrsquos possible to load them just after 45 days from implants insertion This depends on primary intention bone healing with direct formation of bone tissue close incontact with implants and without interposition of connective tissue The aim of this study was to evaluate osseointegration in early loaded PBR implants insertedtogether with bone grafts in atrophic alveolar ridges

REFERENCES

Cornelini R Barone A Covani U Connective tissue grafts in postextraction implants with immediate restoration a prospective controlled clinical study Pract Proced Aesthet Dent 2008 Jul20(6)337-43

Esposito M Grusovin MG Achille H Coulthard P Worthington HV Interventions for replacing missing teeth different times for loading dental implants Cochrane Database Syst Rev 2009 Jan 21(1)CD003878

Friberg B Raghoebar GM et al A 5-year prospective multicenter study on 1-stage smooth-surface Branemark System implants with early loading in edentulous mandibles Int J Oral Maxillofac Implants 2008 May23(3)481-6

Lai HC Zhang ZY Zhuang LF Wang F Liu X Pu YP Early loading of ITI implants supporting maxillary fixed full-arch prostheses Clin Oral Implants Res 2008 Nov19(11)1129-34

Malchiodi L Quaranta A Scarano A Quaranta M Jaw reconstruction with grafted autologous bone early insertion of osseointegrated implants and early prosthetic loading J Oral Maxillofac Surg 2006 Aug64(8)1190-8

Mannai C Early implant loading in severely resorbed maxilla using xenograft autograft and platelet-rich plasma in 97 patients J Oral Maxillofac Surg 2006 Sep64(9)1420-6

Piattelli A Corigliano M Scarano A Quaranta M Bone reactions to early occlusal loading of two-stage titanium plasma-sprayed implants a pilot study in monkeys Int J Periodontics Restorative Dent 1997 Apr17(2)162-9

Sennerby L Gottlow J Clinical outcome of immediatelyearly loading of dental implants A literature review of recent controlled prospective clinical studies Aust Dent J 2008 Jun53 Suppl 1S82-8

MATERIALS AND METHODSIn our Prosthodontics Dept Sapienza University of Rome from November 2004 to October 2007 we selected 24 patients (both sexes 42 years mean age wellhealthy no smokers) having maxillary and mandibular partial atrophic alveolar ridges and asking for implant supported prostheses We inserted 78 rot ormer PBRimplants (TMIreg Pressing Dental San Marino Italy) together with a bone graft material (BioOss Geistlich) Minimum implant diameter was 375mm and minimumlength was 105mm The primary implant stability was estimated by RFA When the ISQ resulted ge 57 value in the 2nd stage surgery they were early loaded (15months from surgery) The ISQ values were subsequently estimated every month until the 6th month then at 9 and 12 months The endoral X-rays have beenexecuted to 0 2 6 9 and 12 months

RESULTSIn the 2nd stage surgery a complete bone defect filling was observed in all the cases except one that was characterized by partial bone defect filling (greater than50 and without flap dehiscence) The most significant ISQ values increase was observed in the first 2 months a further ISQ value increasing was observed until the3rd-4th month and successively the ISQ values levelled on constant shares At the end of the second month just 6 implants (77) of 5 different patients didnrsquot show57 ISQ value Among these implants 2 showed clinical mobility (M) in early time (third and fourth month) and they were removed and indicated like failures Theendoral X-ray didnrsquot show any change of the marginal bone level Clinical and X-ray results analized with T-Student test were statistically significant (Plt0005)

CONCLUSIONSThe timing of bone tissue healing around TMI implants overlap timing of a simple fracture of the jaw bones These results showed as early loading of PBR implants

inserted together bone grafts seems to be a valid technique to restore atrophic alveolar ridges shortening healing time and having quicker clinical case resolution

689

87th General Session amp Exhibition of the IADRMiami Florida - April 1-4 2009

CLINICAL AND HISTOLOGICAL EVALUATION OF ATROPHIC MAXILLARY RIDGES IMPLANT REHABILITATIONI VOZZA S ROSSI AM CARPIO E NICOLINI and G POMPA

Dental School Prosthodontics Department ldquoLa Sapienzardquo University Rome Italy

INTRODUCTION

The latest and new indications about implant surgery and the constant introduction on the market of new components and methodologies go hand in handwith the ever-increasing demand from our patients for a quicker and quicker functional rehabilitation Primary Bone Regeneration (PBR) is a mechanism ofnatural bone healing leading to consolidation of two bone segments in 6 weeks In Implant-Prosthodontics PBR implants let the patient have quickerprosthetic rehabilitation also in case of severe bone atrophy and after guided bone regeneration In fact with PBR implants itrsquos possible to load them justafter 45 days from implants insertion This depends on primary intention bone healing with direct formation of bone tissue close in contact with implants andwithout interposition of connective tissue The aim of this study was to evaluate early loading of PBR (Primary Bone Regeneration) implants insertedtogether with bone grafts in atrophic maxillary ridges

REFERENCES

Attard NJ Zarb GA Immediate and early implant loading protocols a review of clinical studies J Prosthet Dent 2005 Sep 94 (3) 242-58

Brochu JF Anderson JD Zarb GA The influence of early loading on bony crest height and stability a pilot study Int J Prosthodont 2005 Nov-Dec 18 (6) 506-12

Cornelini R Barone A Covani U Connective tissue grafts in postextraction implants with immediate restoration a prospective controlled clinical study Pract Proced Aesthet Dent 2008 Jul20(6)337-43

Esposito M Grusovin MG Achille H Coulthard P Worthington HV Interventions for replacing missing teeth different times for loading dental implants Cochrane Database Syst Rev 2009 Jan 21(1)CD003878

Friberg B Raghoebar GM A 5-year prospective multicenter study on 1-stage smooth-surface Branemark System implants with early loading in edentulous mandibles Int J Oral Maxillofac Implants 2008 May-Jun23(3)481-6

Malchiodi L Quaranta A Scarano A Quaranta M Jaw reconstruction with grafted autologous bone early insertion of osseointegrated implants and early prosthetic loading J Oral Maxillofac Surg 2006 Aug64(8)1190-8

Mannai C Early implant loading in severely resorbed maxilla using xenograft autograft and platelet-rich plasma in 97 patients J Oral Maxillofac Surg 2006 Sep64(9)1420-6

Lai HC Zhang ZY Zhuang LF Wang F Liu X Pu YP Early loading of ITI implants supporting maxillary fixed full-arch prostheses Clin Oral Implants Res 2008 Nov19(11)1129-34

Piattelli A Corigliano M Scarano A Quaranta M Bone reactions to early occlusal loading of two-stage titanium plasma-sprayed implants a pilot study in monkeys Int J Periodontics Restorative Dent 1997 Apr17(2)162-9

Sennerby L Gottlow J Clinical outcome of immediatelyearly loading of dental implants A literature review of recent controlled prospective clinical studies Aust Dent J 2008 Jun53 Suppl 1S82-8

MATERIALS AND METHODSIn our Prosthodontics Dept Sapienza University of Rome from November 2004 to June 2007 a sinus lifting was performed in 8 patients (56 years mean agemale gender initial bone height of 15 -2 mm and bone width of 5 mm) asking for a fixed implant-supported rehabilitation They signed an informed consentIn every patient 2root former PBR implants (TMIreg Pressing Dental San Marino Italy) having 325 diameter and 105mm length were inserted together witha bone graft material (Physiograftreg Ghimas) 25 months after maxillary sinus augmentation one of the implants was retrieved and processed forundecalcified histology while the other one was loaded The endoral X-rays have been executed to 0 2 6 9 and 12 months

RESULTSFrom the histomorphometric analysis the graft material residuals accounted for the 4698 of the bioptical volume marrow spaces for the 1876 and bonefor the 3287 (new bone 2262 native bone 1025) Well-mineralized regenerated bone with lamellar parallel-fibred structure and Haversian systemssurrounded the residual graft material particles The measured BIC amounted to 1694 No connective tissue was observed at the implant boundary surfaceFrom clinical point of view there was no implant failure at the 2nd stage neither mobility nor bleeding on probing The endoral X-rays showed a completebone defect filling and no change of the marginal bone level was observed Clinical and X-ray results analized with T-Student test were statistically significant

(Plt0005) CONCLUSIONSThese results showed as early loading of PBR implants inserted together with bone grafts appears to be suitable for maxillary sinus floor augmentation alsoin critical condition as minimal vertical bone height and shorter healing time

3389

Objectives The aim of this study was to obtain immediate bone reparation in only 6 wks and to predict primary bone apposition

without intermediate growth of the connective tissue

Methods We inserted 128 PBR (Primary Bone Reparation) implants (TMIreg Pressing Dental RSM) into 42 patients of both

genders aged between 29 and 68 yrs After 45 days 25 implants were removed from their sites carefully chosen so as not

to endanger either the final prosthesis plan or the patients health The removed samples were embedded in resin (Tecnovit

Kulzer) histologically prepared (EXAKT) and stained with hematoxylin eosin and methylene blue The same samples

were then examined histologically under an optical microscope (Zeiss and Leitz) at 50-100-200-400X

86th General Session and Exibition of the IADR ndash Metro Toronto Convention Centre Canada

Histologic evaluation of a PBR implant system study in manM CORIGLIANO1 S ROSSI2 AM CARPIO2 and S DI CARLO2

1International Academy of Implantoprosthesis and Osteoconnection Rome Italy 2University

of Rome Sapienza Italy

1 Schenk RK Histologie der Primarien Knocheilung Verh Dtsch ges pathol 1974 54 8-12

2 Corigliano M Vrespa G DrsquoAddona A Casolo F Impianto a guarigione primaria Dental Cadmos 1994 11 60-72

3 Piattelli A Paolantonio M Corigliano M Scarano A Immediate loading of titanium plasma-sprayed screw-shaped implants in man a clinical and histological report of two cases J Periodontol 199768591-

597

3 Corigliano M Barlattani A Gargari M Ottria L Andreana S La riparazione ossea primaria in implantoprotesi possibilitagrave tecnica ed applicazioni Quint Int 2002 910 359-370

4 Cooper LF Rahman A Moriarty J Chaffee N Sacco D Immediate mandibular rehabilitation with endosseous implants simultaneous extraction implant placement and loadingInt J Oral Maxillofac

Implants 200217(4)517-25

5 Gherlone E Albano F Vrespa G Falegatti G Capuano A Carico immediato su impianti post estrattivi immediati Implantologia 2004125-37

6 Forabosco A et al Impianti postestrattivi a carico immediato Doctor Os 200617(1)188-190

6

TMI reg Implant System is composed by

Fig1 Pilot Drill

Fig2 Osteotom ldquo UNICArdquo

Fig3 Implant

2

Results The quantity and the quality of the bone observed histologically

in connection with the radicular titanium prostheses following PBR

registered complete growth The BIC (Bone Implant Contact) measured

all around the removed implants averaged 85 Further there were no

necrotic zones associated with the resorption or substitution with

connective fibrous tissue

Conclusions Our histologic analysis demonstrates that the PBR

implant system is without doubt reliable Actually it permits a

great deal of bone to support the progressive load of dental

prostheses

2

Histological images coloured

with hematoxylineosin and

methilene blue

Surgycal phases

1 Drilling

2 Osteotomy with ldquoUNICArdquo

3 Radicular prostheses

insert

85th General Session amp Exhibition of the IADRNew Orleans 21-24 March 2007

EARLY LOADED IMPLANT SUPPORTED OVERDENTURE 3-YEAR FOLLOW-UP EVALUATIONS ROSSI I VOZZA A GIOVANNETTI MP BASILE S DI CARLO

Dental School Prosthodontics Department ldquoLa Sapienzardquo University Rome Italy

INTRODUCTION

Primary Bone Reparation PBR is a mechanism of natural bone healing determining consolidation of two bone segments in 6 weeks In Implantology PBR implantsconsent to patient having prosthetic rehabilitation briefly because it is possible to load them just in 45 days form fixture insertion This is possible thanking to firstintention bone healing with direct formation of bone tissue in contact with implant and without interposition of connective tissue Times of tissue reparationaround implants are superimposable to times of a simple fracture of maxilla The aim of this study was to evaluate perimplant marginal bone level on early loadedimplants supporting overdenture

REFERENCES

Attard NJ Zarb GA Immediate and early implant loading protocols a literature review of clinical studies J Prosthet Dent 200594(3)242-58

Brochu JF Anderson JD Zarb GA The influence of early loading on bony crest height and stability a pilot study Int J Prosthodont 200518(6)506-12

Chiapasco M Early and immediate restoration and loading of implants in completely edentulous patients Int J Oral Maxillofac Implants 200419 Suppl76-91

Mericske-Stern R Oetterli M Kiener P Mericske E A follow-up study of maxillary implants supporting an overdenture clinical and radiographic results Int J Oral Maxillofac Implants 200217(5)678-86

Misch CE Degidi M 5-year prospective study of immediateearly loading of fixed prostheses in completely edentulous jaw with a bone quality-based implant system Clin Implant Dent Relat Res 20035(1)17-28

Payne AG Tawse-Smith A Thomson WM Duncan WD Kumara R One-stage surgery and early loading of three implants for maxillary overdenture a 1-year report Clin Implant Dent Relat Res 20046(2)61-74

Raghoebar GM Friberg B Grunert I Hobkirk JA Tepper G Wendelhag I 3-year prospective multicenter study on one-stage implant surgery and early loading in the edentulous mandible Clin Implant Dent Relat Res 20035(1)39-46

Raghoebar GM Schoen P Meijer HJ Stellingsma K Vissink A Early loading of endosseous implants in the augmented maxilla a 1-year prospective study Clin Oral Implants Res 200314(6)697-702

MATERIALS AND METHODSIn our Prosthodontics Depratment La Sapienza University of Rome from May 2001 to December November 2003 we selected 30 patients (both sexes 49 yearsmean age no smokers) having maxillary total edentulism and asking for fixed prosthetic rehabilitation We inserted 128 root former implants (TMI PressingDental San Marino) they were early loaded after 45 days Minimum diameter was 42mm and minimum length was 13mm Before cementation of each finalrestoration we executed a periapical X-ray using a digital X-ray system (Den Optix Gendex Dentsply Int) The X-ray controls were executed after 1-3-6-9-12months and then yearly

RESULTSMarginal bone levels were evaluated by 2 different operators using a computerised measure system (Vix-win 2000 Gendex Dentsply Int) During the first yearthere was 028mm mean bone loss while during the next two years it was 017mm according to Albrektsson and Zarb implant success criteria (lt1mm during thefirst year and lt02mm during next years) X-ray results analized with T-Student test were statistically significant (Plt0005)

CONCLUSIONSParameters for the valuation of Implantology success have to be established before discussing about obtained results by this experimentation On the basis ofthis osseointegration definition clinical studies have to be purposed to survey the implant stability under functional loading In this order itrsquos necessary thatduring periodic controls implant mobility has to be evaluated and radiographic examinations have to be executed in a reproducible way for determining the stateof perimplant bone tissue health The implant success is evaluated on the following criteria by Albrektsson and Zarb 1) the not splinted implant has to be clinicallyimmovable 2) on the X-ray no perimplant radiotranslucency marks have to be present 3) vertical bone loss has to be lower than 1mm during the first year ofloading and lower than 02mm yearly in the following years 4) each implant has to be without marks or persistent andor not reversible symptoms for examplepain infections neuropathies paresthesis or penetration into the mandibular canal 5)prosthetic restoration has to satisfy function and aesthetics On thesepreliminary remarks in the anterior upper and lower sectors it should occur a success rate of 90 and 85 on long time respectively after 5 and 10 years in theposterior sectors these percentages have to be about 85 after 5 years and 80 after 10 years The obtained results from this experimentation are encouragingfully respecting implant success criteria by Albrektsson and Zarb These results showed as early loaded implants supporting overdenture are clinically andradiographically well osseointegrated

516

Introduction ndash It has been clearly proved by Ludwig through Fourierrsquos analysis [ Ludwig1993] that ultraweak signals are easly recognazed compared with the background noise if they present a patternthe signals the living matter is able to recognized among a variety of interferential signals are highly complex that is they are made up of different frequency bands Infact the complex signal reaches the biological system as a repetition of weak signals but connected among them in a fixed pattern and it is the

repetition of this pattern that distinguish the ldquotrue signalrdquo from the background noise The action of the CMF identifies as the sum of the effects of superimposed continous and pulsed magnetic fields on biological systemsOn the bone tissue is possible to obtain a neo-osteomorphogenesis increasing the gene expression of the morphogenetic proteins

and modulating the osteoclastogenetic proteins action The same results we can obtain on soft tissue The target of our clinical trial ldquoin vivordquo can demonstrate the effects of Combined Magnetic Field on the bone tissue in oral implantology

Methods 458 patients of both genders aged between 35 and 72 yrs underwent implant surgery associated with GBR according to the protocol of the PBR implant system 1024

fixtures were inserted by means of the TMIreg implant system (Pressing Dental RSM) The MET and CMF (MFI Italy) were applied to all patients for 74 days

Osteogenesis was radiologically controlled after 30 60 90 and 120 days All implants were loaded in 120 days

86th General Session and Exibition of the IADR ndash Metro Toronto Convention Centre Canada

Osteomorphogenesis biostimulated by CMF Combined Magnetic Fields M Corigliano1 S Rossi2 F Crescentini2 A Giovanetti2 S Di Carlo2

1International Academy of Implantoprosthesis and Osteoconnection Rome Italy 2 University of Rome Sapienza Italy

Induttori della TME

applicati

CMF-OS amp BR (1) TME (2) MFI Production

1

2

Stimulated morphogenetic proteins gene expression

and modulation of osteoclastogenesis by CMF induction

FGF-2 FGFai AngiopoietinTrombopoietin EGFConnexin 43 Cox-1 e Cox-2 BMP-2 BMP-4 c-myc e c-fosG-proteinCollagen I osteocalcin

Signal Molecules Erk frac12CREBIRS-1eNOS Cytokine IL1 TNFαTNFβTGkαTGFβPDGFIGF-1IGF-

2FGF Osteoclastogenesis Modulators OPGRank RANKL

M-CSFPGE2 EnzymesCytocrome-OssidaseNaK-ATPase hsp70

ornithine decarboxilase adinylate-cyclase protein kinase C

Densification Proteins and ions Osteocalcin Procollagenionized calcium ALPEstrogen-receptor system

Proteoglycans Collagen IIITP1 TPIII

Results All those who underwent implant therapy with GBR and were treated with the combination of MET and CMF showed complete mineralization in a shorter period of time than that commonly reported in these

cases

Conclusions The combined use of MET and CMF together with the PBR implant system can ameliorate and strengthen the physiological mechanisms of bone reparation

Materials CMF-OS ampBR Inductor of CMF multifrequential and presequential with continous magnetic fields Frequency from 1 to 80Hz Amplitude from 1

a 100μT and field amplifierconcentrator TME inductor of bifrequential fieldAmplitude from 5 a 50G for domiciliary use

Induction Method 6 inductions with CMF every 3 days for 12 mindie and TME domiciliary 30min X 2die X 45 days( inductors MFI Italy)

1 2 3

Soft Tissues unsuccessfull gengivoplasty Fase1 date 11042007 (2)date 11182007 (3)12062007 CMF treated 6 X 12 min induction sequenced every 3days

Ludwig W Magneitc Field Therapy In Alternative Medicine Future Medicine Publishing Washington (1993) McLeod BR Liboff AR Dynamic characteristics of membrane ions in multifield configurations of low-frequency

electromagnetic radiationBioelectromagnetics 19867(2)177-89

Blank M Goodman R Electromagnetic fields may act directly on DNADepartment of Physiology Columbia University New York New York 10032 USA mb32columbiaedu J Cell Biochem 1999 Dec 175(3)369-74

Fig1 Dental-Scan Fig2 Implants Fig3 RX results After 45 days

CMF-TME therapy 1 2 3

Il 060409 consegue una seconda borsa di studio triennale presso il Dipto di Scienze Odontostomatologiche dellrsquoUniversitagrave degli Studi di Roma ldquoLa Sapienzardquo per lo svolgimento di una ricerca sullrsquouso degli impianti TMIreg con il protocollo clinico del carico immediato

Incaricato dallrsquo Anno Accademico 200304 dellrsquoinsegnamento di ldquoTecnologie Protesiche e di Laboratoriordquo (Titolare Prof Giorgio Pompa) presso il Corso di Laurea Specialistico in Odontoiatria e Protesi Dentaria dellrsquo Universitagrave degli Studi di Roma Sapienza

Docente del Master di II livello in ldquoImplantoprotesi in Odontostomatologiardquo

Direttore Prof Manlio Quaranta

presso

il Dipto di Scienze Odontostomatologiche dellrsquo Universitagrave di Roma ldquoSapienzardquo

Il 04 03 2010 consegue il titolo di Dottore di Ricerca in Malattie Odontostomatologiche presso il Dipartimanto di Scienze Odontostomatologiche della Ideg Facoltagrave di Medicina e Chirurgia dellrsquoUniversitagrave degli Studi di Roma ldquoSapienzardquo con una tesi dal titolo

ldquo VALUTAZIONE SPERIMENTALE CLINICO RADIOLOGICA SULLrsquoUSO DEGLI IMPIANTI A RIPARAZIONE OSSEA PRIMARIA NEL CARICO

IMMEDIATO POST ESTRATTIVOrdquo

Il 28052010 riceve il titolo di

Professore a contratto

per lrsquoinsegnamento di

ldquoImplantoprotesi in Odontostomatologiardquo

al Master di II livello presso il Dipto di Scienze Odontostomatologiche della Ideg

Facoltagrave di Medicina e Chirurgia Universitagrave di Roma ldquoSapienzardquo

Autore di numerose pubblicazioni in campo scientifico nazionale e internazionale

87th General Session amp Exhibition of the IADRMiami Florida - April 1-4 2009

CLINICAL EVALUATION OF OSSEOINTEGRATION OF IMPLANTS PLACED IN GRAFTED BONEI VOZZA S ROSSI L PICCOLI and M QUARANTA

Dental School Prosthodontics Department ldquoLa Sapienzardquo University Rome Italy

INTRODUCTION

Primary Bone Regeneration (PBR) is a mechanism of natural bone healing leading to consolidation of two bone segments in 6 weeks In Implant-Prosthodontics

PBR implants let the patient have quicker prosthetic rehabilitation also in case of severe bone atrophy and after guided bone regeneration In fact with PBR implantsitrsquos possible to load them just after 45 days from implants insertion This depends on primary intention bone healing with direct formation of bone tissue close incontact with implants and without interposition of connective tissue The aim of this study was to evaluate osseointegration in early loaded PBR implants insertedtogether with bone grafts in atrophic alveolar ridges

REFERENCES

Cornelini R Barone A Covani U Connective tissue grafts in postextraction implants with immediate restoration a prospective controlled clinical study Pract Proced Aesthet Dent 2008 Jul20(6)337-43

Esposito M Grusovin MG Achille H Coulthard P Worthington HV Interventions for replacing missing teeth different times for loading dental implants Cochrane Database Syst Rev 2009 Jan 21(1)CD003878

Friberg B Raghoebar GM et al A 5-year prospective multicenter study on 1-stage smooth-surface Branemark System implants with early loading in edentulous mandibles Int J Oral Maxillofac Implants 2008 May23(3)481-6

Lai HC Zhang ZY Zhuang LF Wang F Liu X Pu YP Early loading of ITI implants supporting maxillary fixed full-arch prostheses Clin Oral Implants Res 2008 Nov19(11)1129-34

Malchiodi L Quaranta A Scarano A Quaranta M Jaw reconstruction with grafted autologous bone early insertion of osseointegrated implants and early prosthetic loading J Oral Maxillofac Surg 2006 Aug64(8)1190-8

Mannai C Early implant loading in severely resorbed maxilla using xenograft autograft and platelet-rich plasma in 97 patients J Oral Maxillofac Surg 2006 Sep64(9)1420-6

Piattelli A Corigliano M Scarano A Quaranta M Bone reactions to early occlusal loading of two-stage titanium plasma-sprayed implants a pilot study in monkeys Int J Periodontics Restorative Dent 1997 Apr17(2)162-9

Sennerby L Gottlow J Clinical outcome of immediatelyearly loading of dental implants A literature review of recent controlled prospective clinical studies Aust Dent J 2008 Jun53 Suppl 1S82-8

MATERIALS AND METHODSIn our Prosthodontics Dept Sapienza University of Rome from November 2004 to October 2007 we selected 24 patients (both sexes 42 years mean age wellhealthy no smokers) having maxillary and mandibular partial atrophic alveolar ridges and asking for implant supported prostheses We inserted 78 rot ormer PBRimplants (TMIreg Pressing Dental San Marino Italy) together with a bone graft material (BioOss Geistlich) Minimum implant diameter was 375mm and minimumlength was 105mm The primary implant stability was estimated by RFA When the ISQ resulted ge 57 value in the 2nd stage surgery they were early loaded (15months from surgery) The ISQ values were subsequently estimated every month until the 6th month then at 9 and 12 months The endoral X-rays have beenexecuted to 0 2 6 9 and 12 months

RESULTSIn the 2nd stage surgery a complete bone defect filling was observed in all the cases except one that was characterized by partial bone defect filling (greater than50 and without flap dehiscence) The most significant ISQ values increase was observed in the first 2 months a further ISQ value increasing was observed until the3rd-4th month and successively the ISQ values levelled on constant shares At the end of the second month just 6 implants (77) of 5 different patients didnrsquot show57 ISQ value Among these implants 2 showed clinical mobility (M) in early time (third and fourth month) and they were removed and indicated like failures Theendoral X-ray didnrsquot show any change of the marginal bone level Clinical and X-ray results analized with T-Student test were statistically significant (Plt0005)

CONCLUSIONSThe timing of bone tissue healing around TMI implants overlap timing of a simple fracture of the jaw bones These results showed as early loading of PBR implants

inserted together bone grafts seems to be a valid technique to restore atrophic alveolar ridges shortening healing time and having quicker clinical case resolution

689

87th General Session amp Exhibition of the IADRMiami Florida - April 1-4 2009

CLINICAL AND HISTOLOGICAL EVALUATION OF ATROPHIC MAXILLARY RIDGES IMPLANT REHABILITATIONI VOZZA S ROSSI AM CARPIO E NICOLINI and G POMPA

Dental School Prosthodontics Department ldquoLa Sapienzardquo University Rome Italy

INTRODUCTION

The latest and new indications about implant surgery and the constant introduction on the market of new components and methodologies go hand in handwith the ever-increasing demand from our patients for a quicker and quicker functional rehabilitation Primary Bone Regeneration (PBR) is a mechanism ofnatural bone healing leading to consolidation of two bone segments in 6 weeks In Implant-Prosthodontics PBR implants let the patient have quickerprosthetic rehabilitation also in case of severe bone atrophy and after guided bone regeneration In fact with PBR implants itrsquos possible to load them justafter 45 days from implants insertion This depends on primary intention bone healing with direct formation of bone tissue close in contact with implants andwithout interposition of connective tissue The aim of this study was to evaluate early loading of PBR (Primary Bone Regeneration) implants insertedtogether with bone grafts in atrophic maxillary ridges

REFERENCES

Attard NJ Zarb GA Immediate and early implant loading protocols a review of clinical studies J Prosthet Dent 2005 Sep 94 (3) 242-58

Brochu JF Anderson JD Zarb GA The influence of early loading on bony crest height and stability a pilot study Int J Prosthodont 2005 Nov-Dec 18 (6) 506-12

Cornelini R Barone A Covani U Connective tissue grafts in postextraction implants with immediate restoration a prospective controlled clinical study Pract Proced Aesthet Dent 2008 Jul20(6)337-43

Esposito M Grusovin MG Achille H Coulthard P Worthington HV Interventions for replacing missing teeth different times for loading dental implants Cochrane Database Syst Rev 2009 Jan 21(1)CD003878

Friberg B Raghoebar GM A 5-year prospective multicenter study on 1-stage smooth-surface Branemark System implants with early loading in edentulous mandibles Int J Oral Maxillofac Implants 2008 May-Jun23(3)481-6

Malchiodi L Quaranta A Scarano A Quaranta M Jaw reconstruction with grafted autologous bone early insertion of osseointegrated implants and early prosthetic loading J Oral Maxillofac Surg 2006 Aug64(8)1190-8

Mannai C Early implant loading in severely resorbed maxilla using xenograft autograft and platelet-rich plasma in 97 patients J Oral Maxillofac Surg 2006 Sep64(9)1420-6

Lai HC Zhang ZY Zhuang LF Wang F Liu X Pu YP Early loading of ITI implants supporting maxillary fixed full-arch prostheses Clin Oral Implants Res 2008 Nov19(11)1129-34

Piattelli A Corigliano M Scarano A Quaranta M Bone reactions to early occlusal loading of two-stage titanium plasma-sprayed implants a pilot study in monkeys Int J Periodontics Restorative Dent 1997 Apr17(2)162-9

Sennerby L Gottlow J Clinical outcome of immediatelyearly loading of dental implants A literature review of recent controlled prospective clinical studies Aust Dent J 2008 Jun53 Suppl 1S82-8

MATERIALS AND METHODSIn our Prosthodontics Dept Sapienza University of Rome from November 2004 to June 2007 a sinus lifting was performed in 8 patients (56 years mean agemale gender initial bone height of 15 -2 mm and bone width of 5 mm) asking for a fixed implant-supported rehabilitation They signed an informed consentIn every patient 2root former PBR implants (TMIreg Pressing Dental San Marino Italy) having 325 diameter and 105mm length were inserted together witha bone graft material (Physiograftreg Ghimas) 25 months after maxillary sinus augmentation one of the implants was retrieved and processed forundecalcified histology while the other one was loaded The endoral X-rays have been executed to 0 2 6 9 and 12 months

RESULTSFrom the histomorphometric analysis the graft material residuals accounted for the 4698 of the bioptical volume marrow spaces for the 1876 and bonefor the 3287 (new bone 2262 native bone 1025) Well-mineralized regenerated bone with lamellar parallel-fibred structure and Haversian systemssurrounded the residual graft material particles The measured BIC amounted to 1694 No connective tissue was observed at the implant boundary surfaceFrom clinical point of view there was no implant failure at the 2nd stage neither mobility nor bleeding on probing The endoral X-rays showed a completebone defect filling and no change of the marginal bone level was observed Clinical and X-ray results analized with T-Student test were statistically significant

(Plt0005) CONCLUSIONSThese results showed as early loading of PBR implants inserted together with bone grafts appears to be suitable for maxillary sinus floor augmentation alsoin critical condition as minimal vertical bone height and shorter healing time

3389

Objectives The aim of this study was to obtain immediate bone reparation in only 6 wks and to predict primary bone apposition

without intermediate growth of the connective tissue

Methods We inserted 128 PBR (Primary Bone Reparation) implants (TMIreg Pressing Dental RSM) into 42 patients of both

genders aged between 29 and 68 yrs After 45 days 25 implants were removed from their sites carefully chosen so as not

to endanger either the final prosthesis plan or the patients health The removed samples were embedded in resin (Tecnovit

Kulzer) histologically prepared (EXAKT) and stained with hematoxylin eosin and methylene blue The same samples

were then examined histologically under an optical microscope (Zeiss and Leitz) at 50-100-200-400X

86th General Session and Exibition of the IADR ndash Metro Toronto Convention Centre Canada

Histologic evaluation of a PBR implant system study in manM CORIGLIANO1 S ROSSI2 AM CARPIO2 and S DI CARLO2

1International Academy of Implantoprosthesis and Osteoconnection Rome Italy 2University

of Rome Sapienza Italy

1 Schenk RK Histologie der Primarien Knocheilung Verh Dtsch ges pathol 1974 54 8-12

2 Corigliano M Vrespa G DrsquoAddona A Casolo F Impianto a guarigione primaria Dental Cadmos 1994 11 60-72

3 Piattelli A Paolantonio M Corigliano M Scarano A Immediate loading of titanium plasma-sprayed screw-shaped implants in man a clinical and histological report of two cases J Periodontol 199768591-

597

3 Corigliano M Barlattani A Gargari M Ottria L Andreana S La riparazione ossea primaria in implantoprotesi possibilitagrave tecnica ed applicazioni Quint Int 2002 910 359-370

4 Cooper LF Rahman A Moriarty J Chaffee N Sacco D Immediate mandibular rehabilitation with endosseous implants simultaneous extraction implant placement and loadingInt J Oral Maxillofac

Implants 200217(4)517-25

5 Gherlone E Albano F Vrespa G Falegatti G Capuano A Carico immediato su impianti post estrattivi immediati Implantologia 2004125-37

6 Forabosco A et al Impianti postestrattivi a carico immediato Doctor Os 200617(1)188-190

6

TMI reg Implant System is composed by

Fig1 Pilot Drill

Fig2 Osteotom ldquo UNICArdquo

Fig3 Implant

2

Results The quantity and the quality of the bone observed histologically

in connection with the radicular titanium prostheses following PBR

registered complete growth The BIC (Bone Implant Contact) measured

all around the removed implants averaged 85 Further there were no

necrotic zones associated with the resorption or substitution with

connective fibrous tissue

Conclusions Our histologic analysis demonstrates that the PBR

implant system is without doubt reliable Actually it permits a

great deal of bone to support the progressive load of dental

prostheses

2

Histological images coloured

with hematoxylineosin and

methilene blue

Surgycal phases

1 Drilling

2 Osteotomy with ldquoUNICArdquo

3 Radicular prostheses

insert

85th General Session amp Exhibition of the IADRNew Orleans 21-24 March 2007

EARLY LOADED IMPLANT SUPPORTED OVERDENTURE 3-YEAR FOLLOW-UP EVALUATIONS ROSSI I VOZZA A GIOVANNETTI MP BASILE S DI CARLO

Dental School Prosthodontics Department ldquoLa Sapienzardquo University Rome Italy

INTRODUCTION

Primary Bone Reparation PBR is a mechanism of natural bone healing determining consolidation of two bone segments in 6 weeks In Implantology PBR implantsconsent to patient having prosthetic rehabilitation briefly because it is possible to load them just in 45 days form fixture insertion This is possible thanking to firstintention bone healing with direct formation of bone tissue in contact with implant and without interposition of connective tissue Times of tissue reparationaround implants are superimposable to times of a simple fracture of maxilla The aim of this study was to evaluate perimplant marginal bone level on early loadedimplants supporting overdenture

REFERENCES

Attard NJ Zarb GA Immediate and early implant loading protocols a literature review of clinical studies J Prosthet Dent 200594(3)242-58

Brochu JF Anderson JD Zarb GA The influence of early loading on bony crest height and stability a pilot study Int J Prosthodont 200518(6)506-12

Chiapasco M Early and immediate restoration and loading of implants in completely edentulous patients Int J Oral Maxillofac Implants 200419 Suppl76-91

Mericske-Stern R Oetterli M Kiener P Mericske E A follow-up study of maxillary implants supporting an overdenture clinical and radiographic results Int J Oral Maxillofac Implants 200217(5)678-86

Misch CE Degidi M 5-year prospective study of immediateearly loading of fixed prostheses in completely edentulous jaw with a bone quality-based implant system Clin Implant Dent Relat Res 20035(1)17-28

Payne AG Tawse-Smith A Thomson WM Duncan WD Kumara R One-stage surgery and early loading of three implants for maxillary overdenture a 1-year report Clin Implant Dent Relat Res 20046(2)61-74

Raghoebar GM Friberg B Grunert I Hobkirk JA Tepper G Wendelhag I 3-year prospective multicenter study on one-stage implant surgery and early loading in the edentulous mandible Clin Implant Dent Relat Res 20035(1)39-46

Raghoebar GM Schoen P Meijer HJ Stellingsma K Vissink A Early loading of endosseous implants in the augmented maxilla a 1-year prospective study Clin Oral Implants Res 200314(6)697-702

MATERIALS AND METHODSIn our Prosthodontics Depratment La Sapienza University of Rome from May 2001 to December November 2003 we selected 30 patients (both sexes 49 yearsmean age no smokers) having maxillary total edentulism and asking for fixed prosthetic rehabilitation We inserted 128 root former implants (TMI PressingDental San Marino) they were early loaded after 45 days Minimum diameter was 42mm and minimum length was 13mm Before cementation of each finalrestoration we executed a periapical X-ray using a digital X-ray system (Den Optix Gendex Dentsply Int) The X-ray controls were executed after 1-3-6-9-12months and then yearly

RESULTSMarginal bone levels were evaluated by 2 different operators using a computerised measure system (Vix-win 2000 Gendex Dentsply Int) During the first yearthere was 028mm mean bone loss while during the next two years it was 017mm according to Albrektsson and Zarb implant success criteria (lt1mm during thefirst year and lt02mm during next years) X-ray results analized with T-Student test were statistically significant (Plt0005)

CONCLUSIONSParameters for the valuation of Implantology success have to be established before discussing about obtained results by this experimentation On the basis ofthis osseointegration definition clinical studies have to be purposed to survey the implant stability under functional loading In this order itrsquos necessary thatduring periodic controls implant mobility has to be evaluated and radiographic examinations have to be executed in a reproducible way for determining the stateof perimplant bone tissue health The implant success is evaluated on the following criteria by Albrektsson and Zarb 1) the not splinted implant has to be clinicallyimmovable 2) on the X-ray no perimplant radiotranslucency marks have to be present 3) vertical bone loss has to be lower than 1mm during the first year ofloading and lower than 02mm yearly in the following years 4) each implant has to be without marks or persistent andor not reversible symptoms for examplepain infections neuropathies paresthesis or penetration into the mandibular canal 5)prosthetic restoration has to satisfy function and aesthetics On thesepreliminary remarks in the anterior upper and lower sectors it should occur a success rate of 90 and 85 on long time respectively after 5 and 10 years in theposterior sectors these percentages have to be about 85 after 5 years and 80 after 10 years The obtained results from this experimentation are encouragingfully respecting implant success criteria by Albrektsson and Zarb These results showed as early loaded implants supporting overdenture are clinically andradiographically well osseointegrated

516

Introduction ndash It has been clearly proved by Ludwig through Fourierrsquos analysis [ Ludwig1993] that ultraweak signals are easly recognazed compared with the background noise if they present a patternthe signals the living matter is able to recognized among a variety of interferential signals are highly complex that is they are made up of different frequency bands Infact the complex signal reaches the biological system as a repetition of weak signals but connected among them in a fixed pattern and it is the

repetition of this pattern that distinguish the ldquotrue signalrdquo from the background noise The action of the CMF identifies as the sum of the effects of superimposed continous and pulsed magnetic fields on biological systemsOn the bone tissue is possible to obtain a neo-osteomorphogenesis increasing the gene expression of the morphogenetic proteins

and modulating the osteoclastogenetic proteins action The same results we can obtain on soft tissue The target of our clinical trial ldquoin vivordquo can demonstrate the effects of Combined Magnetic Field on the bone tissue in oral implantology

Methods 458 patients of both genders aged between 35 and 72 yrs underwent implant surgery associated with GBR according to the protocol of the PBR implant system 1024

fixtures were inserted by means of the TMIreg implant system (Pressing Dental RSM) The MET and CMF (MFI Italy) were applied to all patients for 74 days

Osteogenesis was radiologically controlled after 30 60 90 and 120 days All implants were loaded in 120 days

86th General Session and Exibition of the IADR ndash Metro Toronto Convention Centre Canada

Osteomorphogenesis biostimulated by CMF Combined Magnetic Fields M Corigliano1 S Rossi2 F Crescentini2 A Giovanetti2 S Di Carlo2

1International Academy of Implantoprosthesis and Osteoconnection Rome Italy 2 University of Rome Sapienza Italy

Induttori della TME

applicati

CMF-OS amp BR (1) TME (2) MFI Production

1

2

Stimulated morphogenetic proteins gene expression

and modulation of osteoclastogenesis by CMF induction

FGF-2 FGFai AngiopoietinTrombopoietin EGFConnexin 43 Cox-1 e Cox-2 BMP-2 BMP-4 c-myc e c-fosG-proteinCollagen I osteocalcin

Signal Molecules Erk frac12CREBIRS-1eNOS Cytokine IL1 TNFαTNFβTGkαTGFβPDGFIGF-1IGF-

2FGF Osteoclastogenesis Modulators OPGRank RANKL

M-CSFPGE2 EnzymesCytocrome-OssidaseNaK-ATPase hsp70

ornithine decarboxilase adinylate-cyclase protein kinase C

Densification Proteins and ions Osteocalcin Procollagenionized calcium ALPEstrogen-receptor system

Proteoglycans Collagen IIITP1 TPIII

Results All those who underwent implant therapy with GBR and were treated with the combination of MET and CMF showed complete mineralization in a shorter period of time than that commonly reported in these

cases

Conclusions The combined use of MET and CMF together with the PBR implant system can ameliorate and strengthen the physiological mechanisms of bone reparation

Materials CMF-OS ampBR Inductor of CMF multifrequential and presequential with continous magnetic fields Frequency from 1 to 80Hz Amplitude from 1

a 100μT and field amplifierconcentrator TME inductor of bifrequential fieldAmplitude from 5 a 50G for domiciliary use

Induction Method 6 inductions with CMF every 3 days for 12 mindie and TME domiciliary 30min X 2die X 45 days( inductors MFI Italy)

1 2 3

Soft Tissues unsuccessfull gengivoplasty Fase1 date 11042007 (2)date 11182007 (3)12062007 CMF treated 6 X 12 min induction sequenced every 3days

Ludwig W Magneitc Field Therapy In Alternative Medicine Future Medicine Publishing Washington (1993) McLeod BR Liboff AR Dynamic characteristics of membrane ions in multifield configurations of low-frequency

electromagnetic radiationBioelectromagnetics 19867(2)177-89

Blank M Goodman R Electromagnetic fields may act directly on DNADepartment of Physiology Columbia University New York New York 10032 USA mb32columbiaedu J Cell Biochem 1999 Dec 175(3)369-74

Fig1 Dental-Scan Fig2 Implants Fig3 RX results After 45 days

CMF-TME therapy 1 2 3

Incaricato dallrsquo Anno Accademico 200304 dellrsquoinsegnamento di ldquoTecnologie Protesiche e di Laboratoriordquo (Titolare Prof Giorgio Pompa) presso il Corso di Laurea Specialistico in Odontoiatria e Protesi Dentaria dellrsquo Universitagrave degli Studi di Roma Sapienza

Docente del Master di II livello in ldquoImplantoprotesi in Odontostomatologiardquo

Direttore Prof Manlio Quaranta

presso

il Dipto di Scienze Odontostomatologiche dellrsquo Universitagrave di Roma ldquoSapienzardquo

Il 04 03 2010 consegue il titolo di Dottore di Ricerca in Malattie Odontostomatologiche presso il Dipartimanto di Scienze Odontostomatologiche della Ideg Facoltagrave di Medicina e Chirurgia dellrsquoUniversitagrave degli Studi di Roma ldquoSapienzardquo con una tesi dal titolo

ldquo VALUTAZIONE SPERIMENTALE CLINICO RADIOLOGICA SULLrsquoUSO DEGLI IMPIANTI A RIPARAZIONE OSSEA PRIMARIA NEL CARICO

IMMEDIATO POST ESTRATTIVOrdquo

Il 28052010 riceve il titolo di

Professore a contratto

per lrsquoinsegnamento di

ldquoImplantoprotesi in Odontostomatologiardquo

al Master di II livello presso il Dipto di Scienze Odontostomatologiche della Ideg

Facoltagrave di Medicina e Chirurgia Universitagrave di Roma ldquoSapienzardquo

Autore di numerose pubblicazioni in campo scientifico nazionale e internazionale

87th General Session amp Exhibition of the IADRMiami Florida - April 1-4 2009

CLINICAL EVALUATION OF OSSEOINTEGRATION OF IMPLANTS PLACED IN GRAFTED BONEI VOZZA S ROSSI L PICCOLI and M QUARANTA

Dental School Prosthodontics Department ldquoLa Sapienzardquo University Rome Italy

INTRODUCTION

Primary Bone Regeneration (PBR) is a mechanism of natural bone healing leading to consolidation of two bone segments in 6 weeks In Implant-Prosthodontics

PBR implants let the patient have quicker prosthetic rehabilitation also in case of severe bone atrophy and after guided bone regeneration In fact with PBR implantsitrsquos possible to load them just after 45 days from implants insertion This depends on primary intention bone healing with direct formation of bone tissue close incontact with implants and without interposition of connective tissue The aim of this study was to evaluate osseointegration in early loaded PBR implants insertedtogether with bone grafts in atrophic alveolar ridges

REFERENCES

Cornelini R Barone A Covani U Connective tissue grafts in postextraction implants with immediate restoration a prospective controlled clinical study Pract Proced Aesthet Dent 2008 Jul20(6)337-43

Esposito M Grusovin MG Achille H Coulthard P Worthington HV Interventions for replacing missing teeth different times for loading dental implants Cochrane Database Syst Rev 2009 Jan 21(1)CD003878

Friberg B Raghoebar GM et al A 5-year prospective multicenter study on 1-stage smooth-surface Branemark System implants with early loading in edentulous mandibles Int J Oral Maxillofac Implants 2008 May23(3)481-6

Lai HC Zhang ZY Zhuang LF Wang F Liu X Pu YP Early loading of ITI implants supporting maxillary fixed full-arch prostheses Clin Oral Implants Res 2008 Nov19(11)1129-34

Malchiodi L Quaranta A Scarano A Quaranta M Jaw reconstruction with grafted autologous bone early insertion of osseointegrated implants and early prosthetic loading J Oral Maxillofac Surg 2006 Aug64(8)1190-8

Mannai C Early implant loading in severely resorbed maxilla using xenograft autograft and platelet-rich plasma in 97 patients J Oral Maxillofac Surg 2006 Sep64(9)1420-6

Piattelli A Corigliano M Scarano A Quaranta M Bone reactions to early occlusal loading of two-stage titanium plasma-sprayed implants a pilot study in monkeys Int J Periodontics Restorative Dent 1997 Apr17(2)162-9

Sennerby L Gottlow J Clinical outcome of immediatelyearly loading of dental implants A literature review of recent controlled prospective clinical studies Aust Dent J 2008 Jun53 Suppl 1S82-8

MATERIALS AND METHODSIn our Prosthodontics Dept Sapienza University of Rome from November 2004 to October 2007 we selected 24 patients (both sexes 42 years mean age wellhealthy no smokers) having maxillary and mandibular partial atrophic alveolar ridges and asking for implant supported prostheses We inserted 78 rot ormer PBRimplants (TMIreg Pressing Dental San Marino Italy) together with a bone graft material (BioOss Geistlich) Minimum implant diameter was 375mm and minimumlength was 105mm The primary implant stability was estimated by RFA When the ISQ resulted ge 57 value in the 2nd stage surgery they were early loaded (15months from surgery) The ISQ values were subsequently estimated every month until the 6th month then at 9 and 12 months The endoral X-rays have beenexecuted to 0 2 6 9 and 12 months

RESULTSIn the 2nd stage surgery a complete bone defect filling was observed in all the cases except one that was characterized by partial bone defect filling (greater than50 and without flap dehiscence) The most significant ISQ values increase was observed in the first 2 months a further ISQ value increasing was observed until the3rd-4th month and successively the ISQ values levelled on constant shares At the end of the second month just 6 implants (77) of 5 different patients didnrsquot show57 ISQ value Among these implants 2 showed clinical mobility (M) in early time (third and fourth month) and they were removed and indicated like failures Theendoral X-ray didnrsquot show any change of the marginal bone level Clinical and X-ray results analized with T-Student test were statistically significant (Plt0005)

CONCLUSIONSThe timing of bone tissue healing around TMI implants overlap timing of a simple fracture of the jaw bones These results showed as early loading of PBR implants

inserted together bone grafts seems to be a valid technique to restore atrophic alveolar ridges shortening healing time and having quicker clinical case resolution

689

87th General Session amp Exhibition of the IADRMiami Florida - April 1-4 2009

CLINICAL AND HISTOLOGICAL EVALUATION OF ATROPHIC MAXILLARY RIDGES IMPLANT REHABILITATIONI VOZZA S ROSSI AM CARPIO E NICOLINI and G POMPA

Dental School Prosthodontics Department ldquoLa Sapienzardquo University Rome Italy

INTRODUCTION

The latest and new indications about implant surgery and the constant introduction on the market of new components and methodologies go hand in handwith the ever-increasing demand from our patients for a quicker and quicker functional rehabilitation Primary Bone Regeneration (PBR) is a mechanism ofnatural bone healing leading to consolidation of two bone segments in 6 weeks In Implant-Prosthodontics PBR implants let the patient have quickerprosthetic rehabilitation also in case of severe bone atrophy and after guided bone regeneration In fact with PBR implants itrsquos possible to load them justafter 45 days from implants insertion This depends on primary intention bone healing with direct formation of bone tissue close in contact with implants andwithout interposition of connective tissue The aim of this study was to evaluate early loading of PBR (Primary Bone Regeneration) implants insertedtogether with bone grafts in atrophic maxillary ridges

REFERENCES

Attard NJ Zarb GA Immediate and early implant loading protocols a review of clinical studies J Prosthet Dent 2005 Sep 94 (3) 242-58

Brochu JF Anderson JD Zarb GA The influence of early loading on bony crest height and stability a pilot study Int J Prosthodont 2005 Nov-Dec 18 (6) 506-12

Cornelini R Barone A Covani U Connective tissue grafts in postextraction implants with immediate restoration a prospective controlled clinical study Pract Proced Aesthet Dent 2008 Jul20(6)337-43

Esposito M Grusovin MG Achille H Coulthard P Worthington HV Interventions for replacing missing teeth different times for loading dental implants Cochrane Database Syst Rev 2009 Jan 21(1)CD003878

Friberg B Raghoebar GM A 5-year prospective multicenter study on 1-stage smooth-surface Branemark System implants with early loading in edentulous mandibles Int J Oral Maxillofac Implants 2008 May-Jun23(3)481-6

Malchiodi L Quaranta A Scarano A Quaranta M Jaw reconstruction with grafted autologous bone early insertion of osseointegrated implants and early prosthetic loading J Oral Maxillofac Surg 2006 Aug64(8)1190-8

Mannai C Early implant loading in severely resorbed maxilla using xenograft autograft and platelet-rich plasma in 97 patients J Oral Maxillofac Surg 2006 Sep64(9)1420-6

Lai HC Zhang ZY Zhuang LF Wang F Liu X Pu YP Early loading of ITI implants supporting maxillary fixed full-arch prostheses Clin Oral Implants Res 2008 Nov19(11)1129-34

Piattelli A Corigliano M Scarano A Quaranta M Bone reactions to early occlusal loading of two-stage titanium plasma-sprayed implants a pilot study in monkeys Int J Periodontics Restorative Dent 1997 Apr17(2)162-9

Sennerby L Gottlow J Clinical outcome of immediatelyearly loading of dental implants A literature review of recent controlled prospective clinical studies Aust Dent J 2008 Jun53 Suppl 1S82-8

MATERIALS AND METHODSIn our Prosthodontics Dept Sapienza University of Rome from November 2004 to June 2007 a sinus lifting was performed in 8 patients (56 years mean agemale gender initial bone height of 15 -2 mm and bone width of 5 mm) asking for a fixed implant-supported rehabilitation They signed an informed consentIn every patient 2root former PBR implants (TMIreg Pressing Dental San Marino Italy) having 325 diameter and 105mm length were inserted together witha bone graft material (Physiograftreg Ghimas) 25 months after maxillary sinus augmentation one of the implants was retrieved and processed forundecalcified histology while the other one was loaded The endoral X-rays have been executed to 0 2 6 9 and 12 months

RESULTSFrom the histomorphometric analysis the graft material residuals accounted for the 4698 of the bioptical volume marrow spaces for the 1876 and bonefor the 3287 (new bone 2262 native bone 1025) Well-mineralized regenerated bone with lamellar parallel-fibred structure and Haversian systemssurrounded the residual graft material particles The measured BIC amounted to 1694 No connective tissue was observed at the implant boundary surfaceFrom clinical point of view there was no implant failure at the 2nd stage neither mobility nor bleeding on probing The endoral X-rays showed a completebone defect filling and no change of the marginal bone level was observed Clinical and X-ray results analized with T-Student test were statistically significant

(Plt0005) CONCLUSIONSThese results showed as early loading of PBR implants inserted together with bone grafts appears to be suitable for maxillary sinus floor augmentation alsoin critical condition as minimal vertical bone height and shorter healing time

3389

Objectives The aim of this study was to obtain immediate bone reparation in only 6 wks and to predict primary bone apposition

without intermediate growth of the connective tissue

Methods We inserted 128 PBR (Primary Bone Reparation) implants (TMIreg Pressing Dental RSM) into 42 patients of both

genders aged between 29 and 68 yrs After 45 days 25 implants were removed from their sites carefully chosen so as not

to endanger either the final prosthesis plan or the patients health The removed samples were embedded in resin (Tecnovit

Kulzer) histologically prepared (EXAKT) and stained with hematoxylin eosin and methylene blue The same samples

were then examined histologically under an optical microscope (Zeiss and Leitz) at 50-100-200-400X

86th General Session and Exibition of the IADR ndash Metro Toronto Convention Centre Canada

Histologic evaluation of a PBR implant system study in manM CORIGLIANO1 S ROSSI2 AM CARPIO2 and S DI CARLO2

1International Academy of Implantoprosthesis and Osteoconnection Rome Italy 2University

of Rome Sapienza Italy

1 Schenk RK Histologie der Primarien Knocheilung Verh Dtsch ges pathol 1974 54 8-12

2 Corigliano M Vrespa G DrsquoAddona A Casolo F Impianto a guarigione primaria Dental Cadmos 1994 11 60-72

3 Piattelli A Paolantonio M Corigliano M Scarano A Immediate loading of titanium plasma-sprayed screw-shaped implants in man a clinical and histological report of two cases J Periodontol 199768591-

597

3 Corigliano M Barlattani A Gargari M Ottria L Andreana S La riparazione ossea primaria in implantoprotesi possibilitagrave tecnica ed applicazioni Quint Int 2002 910 359-370

4 Cooper LF Rahman A Moriarty J Chaffee N Sacco D Immediate mandibular rehabilitation with endosseous implants simultaneous extraction implant placement and loadingInt J Oral Maxillofac

Implants 200217(4)517-25

5 Gherlone E Albano F Vrespa G Falegatti G Capuano A Carico immediato su impianti post estrattivi immediati Implantologia 2004125-37

6 Forabosco A et al Impianti postestrattivi a carico immediato Doctor Os 200617(1)188-190

6

TMI reg Implant System is composed by

Fig1 Pilot Drill

Fig2 Osteotom ldquo UNICArdquo

Fig3 Implant

2

Results The quantity and the quality of the bone observed histologically

in connection with the radicular titanium prostheses following PBR

registered complete growth The BIC (Bone Implant Contact) measured

all around the removed implants averaged 85 Further there were no

necrotic zones associated with the resorption or substitution with

connective fibrous tissue

Conclusions Our histologic analysis demonstrates that the PBR

implant system is without doubt reliable Actually it permits a

great deal of bone to support the progressive load of dental

prostheses

2

Histological images coloured

with hematoxylineosin and

methilene blue

Surgycal phases

1 Drilling

2 Osteotomy with ldquoUNICArdquo

3 Radicular prostheses

insert

85th General Session amp Exhibition of the IADRNew Orleans 21-24 March 2007

EARLY LOADED IMPLANT SUPPORTED OVERDENTURE 3-YEAR FOLLOW-UP EVALUATIONS ROSSI I VOZZA A GIOVANNETTI MP BASILE S DI CARLO

Dental School Prosthodontics Department ldquoLa Sapienzardquo University Rome Italy

INTRODUCTION

Primary Bone Reparation PBR is a mechanism of natural bone healing determining consolidation of two bone segments in 6 weeks In Implantology PBR implantsconsent to patient having prosthetic rehabilitation briefly because it is possible to load them just in 45 days form fixture insertion This is possible thanking to firstintention bone healing with direct formation of bone tissue in contact with implant and without interposition of connective tissue Times of tissue reparationaround implants are superimposable to times of a simple fracture of maxilla The aim of this study was to evaluate perimplant marginal bone level on early loadedimplants supporting overdenture

REFERENCES

Attard NJ Zarb GA Immediate and early implant loading protocols a literature review of clinical studies J Prosthet Dent 200594(3)242-58

Brochu JF Anderson JD Zarb GA The influence of early loading on bony crest height and stability a pilot study Int J Prosthodont 200518(6)506-12

Chiapasco M Early and immediate restoration and loading of implants in completely edentulous patients Int J Oral Maxillofac Implants 200419 Suppl76-91

Mericske-Stern R Oetterli M Kiener P Mericske E A follow-up study of maxillary implants supporting an overdenture clinical and radiographic results Int J Oral Maxillofac Implants 200217(5)678-86

Misch CE Degidi M 5-year prospective study of immediateearly loading of fixed prostheses in completely edentulous jaw with a bone quality-based implant system Clin Implant Dent Relat Res 20035(1)17-28

Payne AG Tawse-Smith A Thomson WM Duncan WD Kumara R One-stage surgery and early loading of three implants for maxillary overdenture a 1-year report Clin Implant Dent Relat Res 20046(2)61-74

Raghoebar GM Friberg B Grunert I Hobkirk JA Tepper G Wendelhag I 3-year prospective multicenter study on one-stage implant surgery and early loading in the edentulous mandible Clin Implant Dent Relat Res 20035(1)39-46

Raghoebar GM Schoen P Meijer HJ Stellingsma K Vissink A Early loading of endosseous implants in the augmented maxilla a 1-year prospective study Clin Oral Implants Res 200314(6)697-702

MATERIALS AND METHODSIn our Prosthodontics Depratment La Sapienza University of Rome from May 2001 to December November 2003 we selected 30 patients (both sexes 49 yearsmean age no smokers) having maxillary total edentulism and asking for fixed prosthetic rehabilitation We inserted 128 root former implants (TMI PressingDental San Marino) they were early loaded after 45 days Minimum diameter was 42mm and minimum length was 13mm Before cementation of each finalrestoration we executed a periapical X-ray using a digital X-ray system (Den Optix Gendex Dentsply Int) The X-ray controls were executed after 1-3-6-9-12months and then yearly

RESULTSMarginal bone levels were evaluated by 2 different operators using a computerised measure system (Vix-win 2000 Gendex Dentsply Int) During the first yearthere was 028mm mean bone loss while during the next two years it was 017mm according to Albrektsson and Zarb implant success criteria (lt1mm during thefirst year and lt02mm during next years) X-ray results analized with T-Student test were statistically significant (Plt0005)

CONCLUSIONSParameters for the valuation of Implantology success have to be established before discussing about obtained results by this experimentation On the basis ofthis osseointegration definition clinical studies have to be purposed to survey the implant stability under functional loading In this order itrsquos necessary thatduring periodic controls implant mobility has to be evaluated and radiographic examinations have to be executed in a reproducible way for determining the stateof perimplant bone tissue health The implant success is evaluated on the following criteria by Albrektsson and Zarb 1) the not splinted implant has to be clinicallyimmovable 2) on the X-ray no perimplant radiotranslucency marks have to be present 3) vertical bone loss has to be lower than 1mm during the first year ofloading and lower than 02mm yearly in the following years 4) each implant has to be without marks or persistent andor not reversible symptoms for examplepain infections neuropathies paresthesis or penetration into the mandibular canal 5)prosthetic restoration has to satisfy function and aesthetics On thesepreliminary remarks in the anterior upper and lower sectors it should occur a success rate of 90 and 85 on long time respectively after 5 and 10 years in theposterior sectors these percentages have to be about 85 after 5 years and 80 after 10 years The obtained results from this experimentation are encouragingfully respecting implant success criteria by Albrektsson and Zarb These results showed as early loaded implants supporting overdenture are clinically andradiographically well osseointegrated

516

Introduction ndash It has been clearly proved by Ludwig through Fourierrsquos analysis [ Ludwig1993] that ultraweak signals are easly recognazed compared with the background noise if they present a patternthe signals the living matter is able to recognized among a variety of interferential signals are highly complex that is they are made up of different frequency bands Infact the complex signal reaches the biological system as a repetition of weak signals but connected among them in a fixed pattern and it is the

repetition of this pattern that distinguish the ldquotrue signalrdquo from the background noise The action of the CMF identifies as the sum of the effects of superimposed continous and pulsed magnetic fields on biological systemsOn the bone tissue is possible to obtain a neo-osteomorphogenesis increasing the gene expression of the morphogenetic proteins

and modulating the osteoclastogenetic proteins action The same results we can obtain on soft tissue The target of our clinical trial ldquoin vivordquo can demonstrate the effects of Combined Magnetic Field on the bone tissue in oral implantology

Methods 458 patients of both genders aged between 35 and 72 yrs underwent implant surgery associated with GBR according to the protocol of the PBR implant system 1024

fixtures were inserted by means of the TMIreg implant system (Pressing Dental RSM) The MET and CMF (MFI Italy) were applied to all patients for 74 days

Osteogenesis was radiologically controlled after 30 60 90 and 120 days All implants were loaded in 120 days

86th General Session and Exibition of the IADR ndash Metro Toronto Convention Centre Canada

Osteomorphogenesis biostimulated by CMF Combined Magnetic Fields M Corigliano1 S Rossi2 F Crescentini2 A Giovanetti2 S Di Carlo2

1International Academy of Implantoprosthesis and Osteoconnection Rome Italy 2 University of Rome Sapienza Italy

Induttori della TME

applicati

CMF-OS amp BR (1) TME (2) MFI Production

1

2

Stimulated morphogenetic proteins gene expression

and modulation of osteoclastogenesis by CMF induction

FGF-2 FGFai AngiopoietinTrombopoietin EGFConnexin 43 Cox-1 e Cox-2 BMP-2 BMP-4 c-myc e c-fosG-proteinCollagen I osteocalcin

Signal Molecules Erk frac12CREBIRS-1eNOS Cytokine IL1 TNFαTNFβTGkαTGFβPDGFIGF-1IGF-

2FGF Osteoclastogenesis Modulators OPGRank RANKL

M-CSFPGE2 EnzymesCytocrome-OssidaseNaK-ATPase hsp70

ornithine decarboxilase adinylate-cyclase protein kinase C

Densification Proteins and ions Osteocalcin Procollagenionized calcium ALPEstrogen-receptor system

Proteoglycans Collagen IIITP1 TPIII

Results All those who underwent implant therapy with GBR and were treated with the combination of MET and CMF showed complete mineralization in a shorter period of time than that commonly reported in these

cases

Conclusions The combined use of MET and CMF together with the PBR implant system can ameliorate and strengthen the physiological mechanisms of bone reparation

Materials CMF-OS ampBR Inductor of CMF multifrequential and presequential with continous magnetic fields Frequency from 1 to 80Hz Amplitude from 1

a 100μT and field amplifierconcentrator TME inductor of bifrequential fieldAmplitude from 5 a 50G for domiciliary use

Induction Method 6 inductions with CMF every 3 days for 12 mindie and TME domiciliary 30min X 2die X 45 days( inductors MFI Italy)

1 2 3

Soft Tissues unsuccessfull gengivoplasty Fase1 date 11042007 (2)date 11182007 (3)12062007 CMF treated 6 X 12 min induction sequenced every 3days

Ludwig W Magneitc Field Therapy In Alternative Medicine Future Medicine Publishing Washington (1993) McLeod BR Liboff AR Dynamic characteristics of membrane ions in multifield configurations of low-frequency

electromagnetic radiationBioelectromagnetics 19867(2)177-89

Blank M Goodman R Electromagnetic fields may act directly on DNADepartment of Physiology Columbia University New York New York 10032 USA mb32columbiaedu J Cell Biochem 1999 Dec 175(3)369-74

Fig1 Dental-Scan Fig2 Implants Fig3 RX results After 45 days

CMF-TME therapy 1 2 3

Docente del Master di II livello in ldquoImplantoprotesi in Odontostomatologiardquo

Direttore Prof Manlio Quaranta

presso

il Dipto di Scienze Odontostomatologiche dellrsquo Universitagrave di Roma ldquoSapienzardquo

Il 04 03 2010 consegue il titolo di Dottore di Ricerca in Malattie Odontostomatologiche presso il Dipartimanto di Scienze Odontostomatologiche della Ideg Facoltagrave di Medicina e Chirurgia dellrsquoUniversitagrave degli Studi di Roma ldquoSapienzardquo con una tesi dal titolo

ldquo VALUTAZIONE SPERIMENTALE CLINICO RADIOLOGICA SULLrsquoUSO DEGLI IMPIANTI A RIPARAZIONE OSSEA PRIMARIA NEL CARICO

IMMEDIATO POST ESTRATTIVOrdquo

Il 28052010 riceve il titolo di

Professore a contratto

per lrsquoinsegnamento di

ldquoImplantoprotesi in Odontostomatologiardquo

al Master di II livello presso il Dipto di Scienze Odontostomatologiche della Ideg

Facoltagrave di Medicina e Chirurgia Universitagrave di Roma ldquoSapienzardquo

Autore di numerose pubblicazioni in campo scientifico nazionale e internazionale

87th General Session amp Exhibition of the IADRMiami Florida - April 1-4 2009

CLINICAL EVALUATION OF OSSEOINTEGRATION OF IMPLANTS PLACED IN GRAFTED BONEI VOZZA S ROSSI L PICCOLI and M QUARANTA

Dental School Prosthodontics Department ldquoLa Sapienzardquo University Rome Italy

INTRODUCTION

Primary Bone Regeneration (PBR) is a mechanism of natural bone healing leading to consolidation of two bone segments in 6 weeks In Implant-Prosthodontics

PBR implants let the patient have quicker prosthetic rehabilitation also in case of severe bone atrophy and after guided bone regeneration In fact with PBR implantsitrsquos possible to load them just after 45 days from implants insertion This depends on primary intention bone healing with direct formation of bone tissue close incontact with implants and without interposition of connective tissue The aim of this study was to evaluate osseointegration in early loaded PBR implants insertedtogether with bone grafts in atrophic alveolar ridges

REFERENCES

Cornelini R Barone A Covani U Connective tissue grafts in postextraction implants with immediate restoration a prospective controlled clinical study Pract Proced Aesthet Dent 2008 Jul20(6)337-43

Esposito M Grusovin MG Achille H Coulthard P Worthington HV Interventions for replacing missing teeth different times for loading dental implants Cochrane Database Syst Rev 2009 Jan 21(1)CD003878

Friberg B Raghoebar GM et al A 5-year prospective multicenter study on 1-stage smooth-surface Branemark System implants with early loading in edentulous mandibles Int J Oral Maxillofac Implants 2008 May23(3)481-6

Lai HC Zhang ZY Zhuang LF Wang F Liu X Pu YP Early loading of ITI implants supporting maxillary fixed full-arch prostheses Clin Oral Implants Res 2008 Nov19(11)1129-34

Malchiodi L Quaranta A Scarano A Quaranta M Jaw reconstruction with grafted autologous bone early insertion of osseointegrated implants and early prosthetic loading J Oral Maxillofac Surg 2006 Aug64(8)1190-8

Mannai C Early implant loading in severely resorbed maxilla using xenograft autograft and platelet-rich plasma in 97 patients J Oral Maxillofac Surg 2006 Sep64(9)1420-6

Piattelli A Corigliano M Scarano A Quaranta M Bone reactions to early occlusal loading of two-stage titanium plasma-sprayed implants a pilot study in monkeys Int J Periodontics Restorative Dent 1997 Apr17(2)162-9

Sennerby L Gottlow J Clinical outcome of immediatelyearly loading of dental implants A literature review of recent controlled prospective clinical studies Aust Dent J 2008 Jun53 Suppl 1S82-8

MATERIALS AND METHODSIn our Prosthodontics Dept Sapienza University of Rome from November 2004 to October 2007 we selected 24 patients (both sexes 42 years mean age wellhealthy no smokers) having maxillary and mandibular partial atrophic alveolar ridges and asking for implant supported prostheses We inserted 78 rot ormer PBRimplants (TMIreg Pressing Dental San Marino Italy) together with a bone graft material (BioOss Geistlich) Minimum implant diameter was 375mm and minimumlength was 105mm The primary implant stability was estimated by RFA When the ISQ resulted ge 57 value in the 2nd stage surgery they were early loaded (15months from surgery) The ISQ values were subsequently estimated every month until the 6th month then at 9 and 12 months The endoral X-rays have beenexecuted to 0 2 6 9 and 12 months

RESULTSIn the 2nd stage surgery a complete bone defect filling was observed in all the cases except one that was characterized by partial bone defect filling (greater than50 and without flap dehiscence) The most significant ISQ values increase was observed in the first 2 months a further ISQ value increasing was observed until the3rd-4th month and successively the ISQ values levelled on constant shares At the end of the second month just 6 implants (77) of 5 different patients didnrsquot show57 ISQ value Among these implants 2 showed clinical mobility (M) in early time (third and fourth month) and they were removed and indicated like failures Theendoral X-ray didnrsquot show any change of the marginal bone level Clinical and X-ray results analized with T-Student test were statistically significant (Plt0005)

CONCLUSIONSThe timing of bone tissue healing around TMI implants overlap timing of a simple fracture of the jaw bones These results showed as early loading of PBR implants

inserted together bone grafts seems to be a valid technique to restore atrophic alveolar ridges shortening healing time and having quicker clinical case resolution

689

87th General Session amp Exhibition of the IADRMiami Florida - April 1-4 2009

CLINICAL AND HISTOLOGICAL EVALUATION OF ATROPHIC MAXILLARY RIDGES IMPLANT REHABILITATIONI VOZZA S ROSSI AM CARPIO E NICOLINI and G POMPA

Dental School Prosthodontics Department ldquoLa Sapienzardquo University Rome Italy

INTRODUCTION

The latest and new indications about implant surgery and the constant introduction on the market of new components and methodologies go hand in handwith the ever-increasing demand from our patients for a quicker and quicker functional rehabilitation Primary Bone Regeneration (PBR) is a mechanism ofnatural bone healing leading to consolidation of two bone segments in 6 weeks In Implant-Prosthodontics PBR implants let the patient have quickerprosthetic rehabilitation also in case of severe bone atrophy and after guided bone regeneration In fact with PBR implants itrsquos possible to load them justafter 45 days from implants insertion This depends on primary intention bone healing with direct formation of bone tissue close in contact with implants andwithout interposition of connective tissue The aim of this study was to evaluate early loading of PBR (Primary Bone Regeneration) implants insertedtogether with bone grafts in atrophic maxillary ridges

REFERENCES

Attard NJ Zarb GA Immediate and early implant loading protocols a review of clinical studies J Prosthet Dent 2005 Sep 94 (3) 242-58

Brochu JF Anderson JD Zarb GA The influence of early loading on bony crest height and stability a pilot study Int J Prosthodont 2005 Nov-Dec 18 (6) 506-12

Cornelini R Barone A Covani U Connective tissue grafts in postextraction implants with immediate restoration a prospective controlled clinical study Pract Proced Aesthet Dent 2008 Jul20(6)337-43

Esposito M Grusovin MG Achille H Coulthard P Worthington HV Interventions for replacing missing teeth different times for loading dental implants Cochrane Database Syst Rev 2009 Jan 21(1)CD003878

Friberg B Raghoebar GM A 5-year prospective multicenter study on 1-stage smooth-surface Branemark System implants with early loading in edentulous mandibles Int J Oral Maxillofac Implants 2008 May-Jun23(3)481-6

Malchiodi L Quaranta A Scarano A Quaranta M Jaw reconstruction with grafted autologous bone early insertion of osseointegrated implants and early prosthetic loading J Oral Maxillofac Surg 2006 Aug64(8)1190-8

Mannai C Early implant loading in severely resorbed maxilla using xenograft autograft and platelet-rich plasma in 97 patients J Oral Maxillofac Surg 2006 Sep64(9)1420-6

Lai HC Zhang ZY Zhuang LF Wang F Liu X Pu YP Early loading of ITI implants supporting maxillary fixed full-arch prostheses Clin Oral Implants Res 2008 Nov19(11)1129-34

Piattelli A Corigliano M Scarano A Quaranta M Bone reactions to early occlusal loading of two-stage titanium plasma-sprayed implants a pilot study in monkeys Int J Periodontics Restorative Dent 1997 Apr17(2)162-9

Sennerby L Gottlow J Clinical outcome of immediatelyearly loading of dental implants A literature review of recent controlled prospective clinical studies Aust Dent J 2008 Jun53 Suppl 1S82-8

MATERIALS AND METHODSIn our Prosthodontics Dept Sapienza University of Rome from November 2004 to June 2007 a sinus lifting was performed in 8 patients (56 years mean agemale gender initial bone height of 15 -2 mm and bone width of 5 mm) asking for a fixed implant-supported rehabilitation They signed an informed consentIn every patient 2root former PBR implants (TMIreg Pressing Dental San Marino Italy) having 325 diameter and 105mm length were inserted together witha bone graft material (Physiograftreg Ghimas) 25 months after maxillary sinus augmentation one of the implants was retrieved and processed forundecalcified histology while the other one was loaded The endoral X-rays have been executed to 0 2 6 9 and 12 months

RESULTSFrom the histomorphometric analysis the graft material residuals accounted for the 4698 of the bioptical volume marrow spaces for the 1876 and bonefor the 3287 (new bone 2262 native bone 1025) Well-mineralized regenerated bone with lamellar parallel-fibred structure and Haversian systemssurrounded the residual graft material particles The measured BIC amounted to 1694 No connective tissue was observed at the implant boundary surfaceFrom clinical point of view there was no implant failure at the 2nd stage neither mobility nor bleeding on probing The endoral X-rays showed a completebone defect filling and no change of the marginal bone level was observed Clinical and X-ray results analized with T-Student test were statistically significant

(Plt0005) CONCLUSIONSThese results showed as early loading of PBR implants inserted together with bone grafts appears to be suitable for maxillary sinus floor augmentation alsoin critical condition as minimal vertical bone height and shorter healing time

3389

Objectives The aim of this study was to obtain immediate bone reparation in only 6 wks and to predict primary bone apposition

without intermediate growth of the connective tissue

Methods We inserted 128 PBR (Primary Bone Reparation) implants (TMIreg Pressing Dental RSM) into 42 patients of both

genders aged between 29 and 68 yrs After 45 days 25 implants were removed from their sites carefully chosen so as not

to endanger either the final prosthesis plan or the patients health The removed samples were embedded in resin (Tecnovit

Kulzer) histologically prepared (EXAKT) and stained with hematoxylin eosin and methylene blue The same samples

were then examined histologically under an optical microscope (Zeiss and Leitz) at 50-100-200-400X

86th General Session and Exibition of the IADR ndash Metro Toronto Convention Centre Canada

Histologic evaluation of a PBR implant system study in manM CORIGLIANO1 S ROSSI2 AM CARPIO2 and S DI CARLO2

1International Academy of Implantoprosthesis and Osteoconnection Rome Italy 2University

of Rome Sapienza Italy

1 Schenk RK Histologie der Primarien Knocheilung Verh Dtsch ges pathol 1974 54 8-12

2 Corigliano M Vrespa G DrsquoAddona A Casolo F Impianto a guarigione primaria Dental Cadmos 1994 11 60-72

3 Piattelli A Paolantonio M Corigliano M Scarano A Immediate loading of titanium plasma-sprayed screw-shaped implants in man a clinical and histological report of two cases J Periodontol 199768591-

597

3 Corigliano M Barlattani A Gargari M Ottria L Andreana S La riparazione ossea primaria in implantoprotesi possibilitagrave tecnica ed applicazioni Quint Int 2002 910 359-370

4 Cooper LF Rahman A Moriarty J Chaffee N Sacco D Immediate mandibular rehabilitation with endosseous implants simultaneous extraction implant placement and loadingInt J Oral Maxillofac

Implants 200217(4)517-25

5 Gherlone E Albano F Vrespa G Falegatti G Capuano A Carico immediato su impianti post estrattivi immediati Implantologia 2004125-37

6 Forabosco A et al Impianti postestrattivi a carico immediato Doctor Os 200617(1)188-190

6

TMI reg Implant System is composed by

Fig1 Pilot Drill

Fig2 Osteotom ldquo UNICArdquo

Fig3 Implant

2

Results The quantity and the quality of the bone observed histologically

in connection with the radicular titanium prostheses following PBR

registered complete growth The BIC (Bone Implant Contact) measured

all around the removed implants averaged 85 Further there were no

necrotic zones associated with the resorption or substitution with

connective fibrous tissue

Conclusions Our histologic analysis demonstrates that the PBR

implant system is without doubt reliable Actually it permits a

great deal of bone to support the progressive load of dental

prostheses

2

Histological images coloured

with hematoxylineosin and

methilene blue

Surgycal phases

1 Drilling

2 Osteotomy with ldquoUNICArdquo

3 Radicular prostheses

insert

85th General Session amp Exhibition of the IADRNew Orleans 21-24 March 2007

EARLY LOADED IMPLANT SUPPORTED OVERDENTURE 3-YEAR FOLLOW-UP EVALUATIONS ROSSI I VOZZA A GIOVANNETTI MP BASILE S DI CARLO

Dental School Prosthodontics Department ldquoLa Sapienzardquo University Rome Italy

INTRODUCTION

Primary Bone Reparation PBR is a mechanism of natural bone healing determining consolidation of two bone segments in 6 weeks In Implantology PBR implantsconsent to patient having prosthetic rehabilitation briefly because it is possible to load them just in 45 days form fixture insertion This is possible thanking to firstintention bone healing with direct formation of bone tissue in contact with implant and without interposition of connective tissue Times of tissue reparationaround implants are superimposable to times of a simple fracture of maxilla The aim of this study was to evaluate perimplant marginal bone level on early loadedimplants supporting overdenture

REFERENCES

Attard NJ Zarb GA Immediate and early implant loading protocols a literature review of clinical studies J Prosthet Dent 200594(3)242-58

Brochu JF Anderson JD Zarb GA The influence of early loading on bony crest height and stability a pilot study Int J Prosthodont 200518(6)506-12

Chiapasco M Early and immediate restoration and loading of implants in completely edentulous patients Int J Oral Maxillofac Implants 200419 Suppl76-91

Mericske-Stern R Oetterli M Kiener P Mericske E A follow-up study of maxillary implants supporting an overdenture clinical and radiographic results Int J Oral Maxillofac Implants 200217(5)678-86

Misch CE Degidi M 5-year prospective study of immediateearly loading of fixed prostheses in completely edentulous jaw with a bone quality-based implant system Clin Implant Dent Relat Res 20035(1)17-28

Payne AG Tawse-Smith A Thomson WM Duncan WD Kumara R One-stage surgery and early loading of three implants for maxillary overdenture a 1-year report Clin Implant Dent Relat Res 20046(2)61-74

Raghoebar GM Friberg B Grunert I Hobkirk JA Tepper G Wendelhag I 3-year prospective multicenter study on one-stage implant surgery and early loading in the edentulous mandible Clin Implant Dent Relat Res 20035(1)39-46

Raghoebar GM Schoen P Meijer HJ Stellingsma K Vissink A Early loading of endosseous implants in the augmented maxilla a 1-year prospective study Clin Oral Implants Res 200314(6)697-702

MATERIALS AND METHODSIn our Prosthodontics Depratment La Sapienza University of Rome from May 2001 to December November 2003 we selected 30 patients (both sexes 49 yearsmean age no smokers) having maxillary total edentulism and asking for fixed prosthetic rehabilitation We inserted 128 root former implants (TMI PressingDental San Marino) they were early loaded after 45 days Minimum diameter was 42mm and minimum length was 13mm Before cementation of each finalrestoration we executed a periapical X-ray using a digital X-ray system (Den Optix Gendex Dentsply Int) The X-ray controls were executed after 1-3-6-9-12months and then yearly

RESULTSMarginal bone levels were evaluated by 2 different operators using a computerised measure system (Vix-win 2000 Gendex Dentsply Int) During the first yearthere was 028mm mean bone loss while during the next two years it was 017mm according to Albrektsson and Zarb implant success criteria (lt1mm during thefirst year and lt02mm during next years) X-ray results analized with T-Student test were statistically significant (Plt0005)

CONCLUSIONSParameters for the valuation of Implantology success have to be established before discussing about obtained results by this experimentation On the basis ofthis osseointegration definition clinical studies have to be purposed to survey the implant stability under functional loading In this order itrsquos necessary thatduring periodic controls implant mobility has to be evaluated and radiographic examinations have to be executed in a reproducible way for determining the stateof perimplant bone tissue health The implant success is evaluated on the following criteria by Albrektsson and Zarb 1) the not splinted implant has to be clinicallyimmovable 2) on the X-ray no perimplant radiotranslucency marks have to be present 3) vertical bone loss has to be lower than 1mm during the first year ofloading and lower than 02mm yearly in the following years 4) each implant has to be without marks or persistent andor not reversible symptoms for examplepain infections neuropathies paresthesis or penetration into the mandibular canal 5)prosthetic restoration has to satisfy function and aesthetics On thesepreliminary remarks in the anterior upper and lower sectors it should occur a success rate of 90 and 85 on long time respectively after 5 and 10 years in theposterior sectors these percentages have to be about 85 after 5 years and 80 after 10 years The obtained results from this experimentation are encouragingfully respecting implant success criteria by Albrektsson and Zarb These results showed as early loaded implants supporting overdenture are clinically andradiographically well osseointegrated

516

Introduction ndash It has been clearly proved by Ludwig through Fourierrsquos analysis [ Ludwig1993] that ultraweak signals are easly recognazed compared with the background noise if they present a patternthe signals the living matter is able to recognized among a variety of interferential signals are highly complex that is they are made up of different frequency bands Infact the complex signal reaches the biological system as a repetition of weak signals but connected among them in a fixed pattern and it is the

repetition of this pattern that distinguish the ldquotrue signalrdquo from the background noise The action of the CMF identifies as the sum of the effects of superimposed continous and pulsed magnetic fields on biological systemsOn the bone tissue is possible to obtain a neo-osteomorphogenesis increasing the gene expression of the morphogenetic proteins

and modulating the osteoclastogenetic proteins action The same results we can obtain on soft tissue The target of our clinical trial ldquoin vivordquo can demonstrate the effects of Combined Magnetic Field on the bone tissue in oral implantology

Methods 458 patients of both genders aged between 35 and 72 yrs underwent implant surgery associated with GBR according to the protocol of the PBR implant system 1024

fixtures were inserted by means of the TMIreg implant system (Pressing Dental RSM) The MET and CMF (MFI Italy) were applied to all patients for 74 days

Osteogenesis was radiologically controlled after 30 60 90 and 120 days All implants were loaded in 120 days

86th General Session and Exibition of the IADR ndash Metro Toronto Convention Centre Canada

Osteomorphogenesis biostimulated by CMF Combined Magnetic Fields M Corigliano1 S Rossi2 F Crescentini2 A Giovanetti2 S Di Carlo2

1International Academy of Implantoprosthesis and Osteoconnection Rome Italy 2 University of Rome Sapienza Italy

Induttori della TME

applicati

CMF-OS amp BR (1) TME (2) MFI Production

1

2

Stimulated morphogenetic proteins gene expression

and modulation of osteoclastogenesis by CMF induction

FGF-2 FGFai AngiopoietinTrombopoietin EGFConnexin 43 Cox-1 e Cox-2 BMP-2 BMP-4 c-myc e c-fosG-proteinCollagen I osteocalcin

Signal Molecules Erk frac12CREBIRS-1eNOS Cytokine IL1 TNFαTNFβTGkαTGFβPDGFIGF-1IGF-

2FGF Osteoclastogenesis Modulators OPGRank RANKL

M-CSFPGE2 EnzymesCytocrome-OssidaseNaK-ATPase hsp70

ornithine decarboxilase adinylate-cyclase protein kinase C

Densification Proteins and ions Osteocalcin Procollagenionized calcium ALPEstrogen-receptor system

Proteoglycans Collagen IIITP1 TPIII

Results All those who underwent implant therapy with GBR and were treated with the combination of MET and CMF showed complete mineralization in a shorter period of time than that commonly reported in these

cases

Conclusions The combined use of MET and CMF together with the PBR implant system can ameliorate and strengthen the physiological mechanisms of bone reparation

Materials CMF-OS ampBR Inductor of CMF multifrequential and presequential with continous magnetic fields Frequency from 1 to 80Hz Amplitude from 1

a 100μT and field amplifierconcentrator TME inductor of bifrequential fieldAmplitude from 5 a 50G for domiciliary use

Induction Method 6 inductions with CMF every 3 days for 12 mindie and TME domiciliary 30min X 2die X 45 days( inductors MFI Italy)

1 2 3

Soft Tissues unsuccessfull gengivoplasty Fase1 date 11042007 (2)date 11182007 (3)12062007 CMF treated 6 X 12 min induction sequenced every 3days

Ludwig W Magneitc Field Therapy In Alternative Medicine Future Medicine Publishing Washington (1993) McLeod BR Liboff AR Dynamic characteristics of membrane ions in multifield configurations of low-frequency

electromagnetic radiationBioelectromagnetics 19867(2)177-89

Blank M Goodman R Electromagnetic fields may act directly on DNADepartment of Physiology Columbia University New York New York 10032 USA mb32columbiaedu J Cell Biochem 1999 Dec 175(3)369-74

Fig1 Dental-Scan Fig2 Implants Fig3 RX results After 45 days

CMF-TME therapy 1 2 3

Il 04 03 2010 consegue il titolo di Dottore di Ricerca in Malattie Odontostomatologiche presso il Dipartimanto di Scienze Odontostomatologiche della Ideg Facoltagrave di Medicina e Chirurgia dellrsquoUniversitagrave degli Studi di Roma ldquoSapienzardquo con una tesi dal titolo

ldquo VALUTAZIONE SPERIMENTALE CLINICO RADIOLOGICA SULLrsquoUSO DEGLI IMPIANTI A RIPARAZIONE OSSEA PRIMARIA NEL CARICO

IMMEDIATO POST ESTRATTIVOrdquo

Il 28052010 riceve il titolo di

Professore a contratto

per lrsquoinsegnamento di

ldquoImplantoprotesi in Odontostomatologiardquo

al Master di II livello presso il Dipto di Scienze Odontostomatologiche della Ideg

Facoltagrave di Medicina e Chirurgia Universitagrave di Roma ldquoSapienzardquo

Autore di numerose pubblicazioni in campo scientifico nazionale e internazionale

87th General Session amp Exhibition of the IADRMiami Florida - April 1-4 2009

CLINICAL EVALUATION OF OSSEOINTEGRATION OF IMPLANTS PLACED IN GRAFTED BONEI VOZZA S ROSSI L PICCOLI and M QUARANTA

Dental School Prosthodontics Department ldquoLa Sapienzardquo University Rome Italy

INTRODUCTION

Primary Bone Regeneration (PBR) is a mechanism of natural bone healing leading to consolidation of two bone segments in 6 weeks In Implant-Prosthodontics

PBR implants let the patient have quicker prosthetic rehabilitation also in case of severe bone atrophy and after guided bone regeneration In fact with PBR implantsitrsquos possible to load them just after 45 days from implants insertion This depends on primary intention bone healing with direct formation of bone tissue close incontact with implants and without interposition of connective tissue The aim of this study was to evaluate osseointegration in early loaded PBR implants insertedtogether with bone grafts in atrophic alveolar ridges

REFERENCES

Cornelini R Barone A Covani U Connective tissue grafts in postextraction implants with immediate restoration a prospective controlled clinical study Pract Proced Aesthet Dent 2008 Jul20(6)337-43

Esposito M Grusovin MG Achille H Coulthard P Worthington HV Interventions for replacing missing teeth different times for loading dental implants Cochrane Database Syst Rev 2009 Jan 21(1)CD003878

Friberg B Raghoebar GM et al A 5-year prospective multicenter study on 1-stage smooth-surface Branemark System implants with early loading in edentulous mandibles Int J Oral Maxillofac Implants 2008 May23(3)481-6

Lai HC Zhang ZY Zhuang LF Wang F Liu X Pu YP Early loading of ITI implants supporting maxillary fixed full-arch prostheses Clin Oral Implants Res 2008 Nov19(11)1129-34

Malchiodi L Quaranta A Scarano A Quaranta M Jaw reconstruction with grafted autologous bone early insertion of osseointegrated implants and early prosthetic loading J Oral Maxillofac Surg 2006 Aug64(8)1190-8

Mannai C Early implant loading in severely resorbed maxilla using xenograft autograft and platelet-rich plasma in 97 patients J Oral Maxillofac Surg 2006 Sep64(9)1420-6

Piattelli A Corigliano M Scarano A Quaranta M Bone reactions to early occlusal loading of two-stage titanium plasma-sprayed implants a pilot study in monkeys Int J Periodontics Restorative Dent 1997 Apr17(2)162-9

Sennerby L Gottlow J Clinical outcome of immediatelyearly loading of dental implants A literature review of recent controlled prospective clinical studies Aust Dent J 2008 Jun53 Suppl 1S82-8

MATERIALS AND METHODSIn our Prosthodontics Dept Sapienza University of Rome from November 2004 to October 2007 we selected 24 patients (both sexes 42 years mean age wellhealthy no smokers) having maxillary and mandibular partial atrophic alveolar ridges and asking for implant supported prostheses We inserted 78 rot ormer PBRimplants (TMIreg Pressing Dental San Marino Italy) together with a bone graft material (BioOss Geistlich) Minimum implant diameter was 375mm and minimumlength was 105mm The primary implant stability was estimated by RFA When the ISQ resulted ge 57 value in the 2nd stage surgery they were early loaded (15months from surgery) The ISQ values were subsequently estimated every month until the 6th month then at 9 and 12 months The endoral X-rays have beenexecuted to 0 2 6 9 and 12 months

RESULTSIn the 2nd stage surgery a complete bone defect filling was observed in all the cases except one that was characterized by partial bone defect filling (greater than50 and without flap dehiscence) The most significant ISQ values increase was observed in the first 2 months a further ISQ value increasing was observed until the3rd-4th month and successively the ISQ values levelled on constant shares At the end of the second month just 6 implants (77) of 5 different patients didnrsquot show57 ISQ value Among these implants 2 showed clinical mobility (M) in early time (third and fourth month) and they were removed and indicated like failures Theendoral X-ray didnrsquot show any change of the marginal bone level Clinical and X-ray results analized with T-Student test were statistically significant (Plt0005)

CONCLUSIONSThe timing of bone tissue healing around TMI implants overlap timing of a simple fracture of the jaw bones These results showed as early loading of PBR implants

inserted together bone grafts seems to be a valid technique to restore atrophic alveolar ridges shortening healing time and having quicker clinical case resolution

689

87th General Session amp Exhibition of the IADRMiami Florida - April 1-4 2009

CLINICAL AND HISTOLOGICAL EVALUATION OF ATROPHIC MAXILLARY RIDGES IMPLANT REHABILITATIONI VOZZA S ROSSI AM CARPIO E NICOLINI and G POMPA

Dental School Prosthodontics Department ldquoLa Sapienzardquo University Rome Italy

INTRODUCTION

The latest and new indications about implant surgery and the constant introduction on the market of new components and methodologies go hand in handwith the ever-increasing demand from our patients for a quicker and quicker functional rehabilitation Primary Bone Regeneration (PBR) is a mechanism ofnatural bone healing leading to consolidation of two bone segments in 6 weeks In Implant-Prosthodontics PBR implants let the patient have quickerprosthetic rehabilitation also in case of severe bone atrophy and after guided bone regeneration In fact with PBR implants itrsquos possible to load them justafter 45 days from implants insertion This depends on primary intention bone healing with direct formation of bone tissue close in contact with implants andwithout interposition of connective tissue The aim of this study was to evaluate early loading of PBR (Primary Bone Regeneration) implants insertedtogether with bone grafts in atrophic maxillary ridges

REFERENCES

Attard NJ Zarb GA Immediate and early implant loading protocols a review of clinical studies J Prosthet Dent 2005 Sep 94 (3) 242-58

Brochu JF Anderson JD Zarb GA The influence of early loading on bony crest height and stability a pilot study Int J Prosthodont 2005 Nov-Dec 18 (6) 506-12

Cornelini R Barone A Covani U Connective tissue grafts in postextraction implants with immediate restoration a prospective controlled clinical study Pract Proced Aesthet Dent 2008 Jul20(6)337-43

Esposito M Grusovin MG Achille H Coulthard P Worthington HV Interventions for replacing missing teeth different times for loading dental implants Cochrane Database Syst Rev 2009 Jan 21(1)CD003878

Friberg B Raghoebar GM A 5-year prospective multicenter study on 1-stage smooth-surface Branemark System implants with early loading in edentulous mandibles Int J Oral Maxillofac Implants 2008 May-Jun23(3)481-6

Malchiodi L Quaranta A Scarano A Quaranta M Jaw reconstruction with grafted autologous bone early insertion of osseointegrated implants and early prosthetic loading J Oral Maxillofac Surg 2006 Aug64(8)1190-8

Mannai C Early implant loading in severely resorbed maxilla using xenograft autograft and platelet-rich plasma in 97 patients J Oral Maxillofac Surg 2006 Sep64(9)1420-6

Lai HC Zhang ZY Zhuang LF Wang F Liu X Pu YP Early loading of ITI implants supporting maxillary fixed full-arch prostheses Clin Oral Implants Res 2008 Nov19(11)1129-34

Piattelli A Corigliano M Scarano A Quaranta M Bone reactions to early occlusal loading of two-stage titanium plasma-sprayed implants a pilot study in monkeys Int J Periodontics Restorative Dent 1997 Apr17(2)162-9

Sennerby L Gottlow J Clinical outcome of immediatelyearly loading of dental implants A literature review of recent controlled prospective clinical studies Aust Dent J 2008 Jun53 Suppl 1S82-8

MATERIALS AND METHODSIn our Prosthodontics Dept Sapienza University of Rome from November 2004 to June 2007 a sinus lifting was performed in 8 patients (56 years mean agemale gender initial bone height of 15 -2 mm and bone width of 5 mm) asking for a fixed implant-supported rehabilitation They signed an informed consentIn every patient 2root former PBR implants (TMIreg Pressing Dental San Marino Italy) having 325 diameter and 105mm length were inserted together witha bone graft material (Physiograftreg Ghimas) 25 months after maxillary sinus augmentation one of the implants was retrieved and processed forundecalcified histology while the other one was loaded The endoral X-rays have been executed to 0 2 6 9 and 12 months

RESULTSFrom the histomorphometric analysis the graft material residuals accounted for the 4698 of the bioptical volume marrow spaces for the 1876 and bonefor the 3287 (new bone 2262 native bone 1025) Well-mineralized regenerated bone with lamellar parallel-fibred structure and Haversian systemssurrounded the residual graft material particles The measured BIC amounted to 1694 No connective tissue was observed at the implant boundary surfaceFrom clinical point of view there was no implant failure at the 2nd stage neither mobility nor bleeding on probing The endoral X-rays showed a completebone defect filling and no change of the marginal bone level was observed Clinical and X-ray results analized with T-Student test were statistically significant

(Plt0005) CONCLUSIONSThese results showed as early loading of PBR implants inserted together with bone grafts appears to be suitable for maxillary sinus floor augmentation alsoin critical condition as minimal vertical bone height and shorter healing time

3389

Objectives The aim of this study was to obtain immediate bone reparation in only 6 wks and to predict primary bone apposition

without intermediate growth of the connective tissue

Methods We inserted 128 PBR (Primary Bone Reparation) implants (TMIreg Pressing Dental RSM) into 42 patients of both

genders aged between 29 and 68 yrs After 45 days 25 implants were removed from their sites carefully chosen so as not

to endanger either the final prosthesis plan or the patients health The removed samples were embedded in resin (Tecnovit

Kulzer) histologically prepared (EXAKT) and stained with hematoxylin eosin and methylene blue The same samples

were then examined histologically under an optical microscope (Zeiss and Leitz) at 50-100-200-400X

86th General Session and Exibition of the IADR ndash Metro Toronto Convention Centre Canada

Histologic evaluation of a PBR implant system study in manM CORIGLIANO1 S ROSSI2 AM CARPIO2 and S DI CARLO2

1International Academy of Implantoprosthesis and Osteoconnection Rome Italy 2University

of Rome Sapienza Italy

1 Schenk RK Histologie der Primarien Knocheilung Verh Dtsch ges pathol 1974 54 8-12

2 Corigliano M Vrespa G DrsquoAddona A Casolo F Impianto a guarigione primaria Dental Cadmos 1994 11 60-72

3 Piattelli A Paolantonio M Corigliano M Scarano A Immediate loading of titanium plasma-sprayed screw-shaped implants in man a clinical and histological report of two cases J Periodontol 199768591-

597

3 Corigliano M Barlattani A Gargari M Ottria L Andreana S La riparazione ossea primaria in implantoprotesi possibilitagrave tecnica ed applicazioni Quint Int 2002 910 359-370

4 Cooper LF Rahman A Moriarty J Chaffee N Sacco D Immediate mandibular rehabilitation with endosseous implants simultaneous extraction implant placement and loadingInt J Oral Maxillofac

Implants 200217(4)517-25

5 Gherlone E Albano F Vrespa G Falegatti G Capuano A Carico immediato su impianti post estrattivi immediati Implantologia 2004125-37

6 Forabosco A et al Impianti postestrattivi a carico immediato Doctor Os 200617(1)188-190

6

TMI reg Implant System is composed by

Fig1 Pilot Drill

Fig2 Osteotom ldquo UNICArdquo

Fig3 Implant

2

Results The quantity and the quality of the bone observed histologically

in connection with the radicular titanium prostheses following PBR

registered complete growth The BIC (Bone Implant Contact) measured

all around the removed implants averaged 85 Further there were no

necrotic zones associated with the resorption or substitution with

connective fibrous tissue

Conclusions Our histologic analysis demonstrates that the PBR

implant system is without doubt reliable Actually it permits a

great deal of bone to support the progressive load of dental

prostheses

2

Histological images coloured

with hematoxylineosin and

methilene blue

Surgycal phases

1 Drilling

2 Osteotomy with ldquoUNICArdquo

3 Radicular prostheses

insert

85th General Session amp Exhibition of the IADRNew Orleans 21-24 March 2007

EARLY LOADED IMPLANT SUPPORTED OVERDENTURE 3-YEAR FOLLOW-UP EVALUATIONS ROSSI I VOZZA A GIOVANNETTI MP BASILE S DI CARLO

Dental School Prosthodontics Department ldquoLa Sapienzardquo University Rome Italy

INTRODUCTION

Primary Bone Reparation PBR is a mechanism of natural bone healing determining consolidation of two bone segments in 6 weeks In Implantology PBR implantsconsent to patient having prosthetic rehabilitation briefly because it is possible to load them just in 45 days form fixture insertion This is possible thanking to firstintention bone healing with direct formation of bone tissue in contact with implant and without interposition of connective tissue Times of tissue reparationaround implants are superimposable to times of a simple fracture of maxilla The aim of this study was to evaluate perimplant marginal bone level on early loadedimplants supporting overdenture

REFERENCES

Attard NJ Zarb GA Immediate and early implant loading protocols a literature review of clinical studies J Prosthet Dent 200594(3)242-58

Brochu JF Anderson JD Zarb GA The influence of early loading on bony crest height and stability a pilot study Int J Prosthodont 200518(6)506-12

Chiapasco M Early and immediate restoration and loading of implants in completely edentulous patients Int J Oral Maxillofac Implants 200419 Suppl76-91

Mericske-Stern R Oetterli M Kiener P Mericske E A follow-up study of maxillary implants supporting an overdenture clinical and radiographic results Int J Oral Maxillofac Implants 200217(5)678-86

Misch CE Degidi M 5-year prospective study of immediateearly loading of fixed prostheses in completely edentulous jaw with a bone quality-based implant system Clin Implant Dent Relat Res 20035(1)17-28

Payne AG Tawse-Smith A Thomson WM Duncan WD Kumara R One-stage surgery and early loading of three implants for maxillary overdenture a 1-year report Clin Implant Dent Relat Res 20046(2)61-74

Raghoebar GM Friberg B Grunert I Hobkirk JA Tepper G Wendelhag I 3-year prospective multicenter study on one-stage implant surgery and early loading in the edentulous mandible Clin Implant Dent Relat Res 20035(1)39-46

Raghoebar GM Schoen P Meijer HJ Stellingsma K Vissink A Early loading of endosseous implants in the augmented maxilla a 1-year prospective study Clin Oral Implants Res 200314(6)697-702

MATERIALS AND METHODSIn our Prosthodontics Depratment La Sapienza University of Rome from May 2001 to December November 2003 we selected 30 patients (both sexes 49 yearsmean age no smokers) having maxillary total edentulism and asking for fixed prosthetic rehabilitation We inserted 128 root former implants (TMI PressingDental San Marino) they were early loaded after 45 days Minimum diameter was 42mm and minimum length was 13mm Before cementation of each finalrestoration we executed a periapical X-ray using a digital X-ray system (Den Optix Gendex Dentsply Int) The X-ray controls were executed after 1-3-6-9-12months and then yearly

RESULTSMarginal bone levels were evaluated by 2 different operators using a computerised measure system (Vix-win 2000 Gendex Dentsply Int) During the first yearthere was 028mm mean bone loss while during the next two years it was 017mm according to Albrektsson and Zarb implant success criteria (lt1mm during thefirst year and lt02mm during next years) X-ray results analized with T-Student test were statistically significant (Plt0005)

CONCLUSIONSParameters for the valuation of Implantology success have to be established before discussing about obtained results by this experimentation On the basis ofthis osseointegration definition clinical studies have to be purposed to survey the implant stability under functional loading In this order itrsquos necessary thatduring periodic controls implant mobility has to be evaluated and radiographic examinations have to be executed in a reproducible way for determining the stateof perimplant bone tissue health The implant success is evaluated on the following criteria by Albrektsson and Zarb 1) the not splinted implant has to be clinicallyimmovable 2) on the X-ray no perimplant radiotranslucency marks have to be present 3) vertical bone loss has to be lower than 1mm during the first year ofloading and lower than 02mm yearly in the following years 4) each implant has to be without marks or persistent andor not reversible symptoms for examplepain infections neuropathies paresthesis or penetration into the mandibular canal 5)prosthetic restoration has to satisfy function and aesthetics On thesepreliminary remarks in the anterior upper and lower sectors it should occur a success rate of 90 and 85 on long time respectively after 5 and 10 years in theposterior sectors these percentages have to be about 85 after 5 years and 80 after 10 years The obtained results from this experimentation are encouragingfully respecting implant success criteria by Albrektsson and Zarb These results showed as early loaded implants supporting overdenture are clinically andradiographically well osseointegrated

516

Introduction ndash It has been clearly proved by Ludwig through Fourierrsquos analysis [ Ludwig1993] that ultraweak signals are easly recognazed compared with the background noise if they present a patternthe signals the living matter is able to recognized among a variety of interferential signals are highly complex that is they are made up of different frequency bands Infact the complex signal reaches the biological system as a repetition of weak signals but connected among them in a fixed pattern and it is the

repetition of this pattern that distinguish the ldquotrue signalrdquo from the background noise The action of the CMF identifies as the sum of the effects of superimposed continous and pulsed magnetic fields on biological systemsOn the bone tissue is possible to obtain a neo-osteomorphogenesis increasing the gene expression of the morphogenetic proteins

and modulating the osteoclastogenetic proteins action The same results we can obtain on soft tissue The target of our clinical trial ldquoin vivordquo can demonstrate the effects of Combined Magnetic Field on the bone tissue in oral implantology

Methods 458 patients of both genders aged between 35 and 72 yrs underwent implant surgery associated with GBR according to the protocol of the PBR implant system 1024

fixtures were inserted by means of the TMIreg implant system (Pressing Dental RSM) The MET and CMF (MFI Italy) were applied to all patients for 74 days

Osteogenesis was radiologically controlled after 30 60 90 and 120 days All implants were loaded in 120 days

86th General Session and Exibition of the IADR ndash Metro Toronto Convention Centre Canada

Osteomorphogenesis biostimulated by CMF Combined Magnetic Fields M Corigliano1 S Rossi2 F Crescentini2 A Giovanetti2 S Di Carlo2

1International Academy of Implantoprosthesis and Osteoconnection Rome Italy 2 University of Rome Sapienza Italy

Induttori della TME

applicati

CMF-OS amp BR (1) TME (2) MFI Production

1

2

Stimulated morphogenetic proteins gene expression

and modulation of osteoclastogenesis by CMF induction

FGF-2 FGFai AngiopoietinTrombopoietin EGFConnexin 43 Cox-1 e Cox-2 BMP-2 BMP-4 c-myc e c-fosG-proteinCollagen I osteocalcin

Signal Molecules Erk frac12CREBIRS-1eNOS Cytokine IL1 TNFαTNFβTGkαTGFβPDGFIGF-1IGF-

2FGF Osteoclastogenesis Modulators OPGRank RANKL

M-CSFPGE2 EnzymesCytocrome-OssidaseNaK-ATPase hsp70

ornithine decarboxilase adinylate-cyclase protein kinase C

Densification Proteins and ions Osteocalcin Procollagenionized calcium ALPEstrogen-receptor system

Proteoglycans Collagen IIITP1 TPIII

Results All those who underwent implant therapy with GBR and were treated with the combination of MET and CMF showed complete mineralization in a shorter period of time than that commonly reported in these

cases

Conclusions The combined use of MET and CMF together with the PBR implant system can ameliorate and strengthen the physiological mechanisms of bone reparation

Materials CMF-OS ampBR Inductor of CMF multifrequential and presequential with continous magnetic fields Frequency from 1 to 80Hz Amplitude from 1

a 100μT and field amplifierconcentrator TME inductor of bifrequential fieldAmplitude from 5 a 50G for domiciliary use

Induction Method 6 inductions with CMF every 3 days for 12 mindie and TME domiciliary 30min X 2die X 45 days( inductors MFI Italy)

1 2 3

Soft Tissues unsuccessfull gengivoplasty Fase1 date 11042007 (2)date 11182007 (3)12062007 CMF treated 6 X 12 min induction sequenced every 3days

Ludwig W Magneitc Field Therapy In Alternative Medicine Future Medicine Publishing Washington (1993) McLeod BR Liboff AR Dynamic characteristics of membrane ions in multifield configurations of low-frequency

electromagnetic radiationBioelectromagnetics 19867(2)177-89

Blank M Goodman R Electromagnetic fields may act directly on DNADepartment of Physiology Columbia University New York New York 10032 USA mb32columbiaedu J Cell Biochem 1999 Dec 175(3)369-74

Fig1 Dental-Scan Fig2 Implants Fig3 RX results After 45 days

CMF-TME therapy 1 2 3

Il 28052010 riceve il titolo di

Professore a contratto

per lrsquoinsegnamento di

ldquoImplantoprotesi in Odontostomatologiardquo

al Master di II livello presso il Dipto di Scienze Odontostomatologiche della Ideg

Facoltagrave di Medicina e Chirurgia Universitagrave di Roma ldquoSapienzardquo

Autore di numerose pubblicazioni in campo scientifico nazionale e internazionale

87th General Session amp Exhibition of the IADRMiami Florida - April 1-4 2009

CLINICAL EVALUATION OF OSSEOINTEGRATION OF IMPLANTS PLACED IN GRAFTED BONEI VOZZA S ROSSI L PICCOLI and M QUARANTA

Dental School Prosthodontics Department ldquoLa Sapienzardquo University Rome Italy

INTRODUCTION

Primary Bone Regeneration (PBR) is a mechanism of natural bone healing leading to consolidation of two bone segments in 6 weeks In Implant-Prosthodontics

PBR implants let the patient have quicker prosthetic rehabilitation also in case of severe bone atrophy and after guided bone regeneration In fact with PBR implantsitrsquos possible to load them just after 45 days from implants insertion This depends on primary intention bone healing with direct formation of bone tissue close incontact with implants and without interposition of connective tissue The aim of this study was to evaluate osseointegration in early loaded PBR implants insertedtogether with bone grafts in atrophic alveolar ridges

REFERENCES

Cornelini R Barone A Covani U Connective tissue grafts in postextraction implants with immediate restoration a prospective controlled clinical study Pract Proced Aesthet Dent 2008 Jul20(6)337-43

Esposito M Grusovin MG Achille H Coulthard P Worthington HV Interventions for replacing missing teeth different times for loading dental implants Cochrane Database Syst Rev 2009 Jan 21(1)CD003878

Friberg B Raghoebar GM et al A 5-year prospective multicenter study on 1-stage smooth-surface Branemark System implants with early loading in edentulous mandibles Int J Oral Maxillofac Implants 2008 May23(3)481-6

Lai HC Zhang ZY Zhuang LF Wang F Liu X Pu YP Early loading of ITI implants supporting maxillary fixed full-arch prostheses Clin Oral Implants Res 2008 Nov19(11)1129-34

Malchiodi L Quaranta A Scarano A Quaranta M Jaw reconstruction with grafted autologous bone early insertion of osseointegrated implants and early prosthetic loading J Oral Maxillofac Surg 2006 Aug64(8)1190-8

Mannai C Early implant loading in severely resorbed maxilla using xenograft autograft and platelet-rich plasma in 97 patients J Oral Maxillofac Surg 2006 Sep64(9)1420-6

Piattelli A Corigliano M Scarano A Quaranta M Bone reactions to early occlusal loading of two-stage titanium plasma-sprayed implants a pilot study in monkeys Int J Periodontics Restorative Dent 1997 Apr17(2)162-9

Sennerby L Gottlow J Clinical outcome of immediatelyearly loading of dental implants A literature review of recent controlled prospective clinical studies Aust Dent J 2008 Jun53 Suppl 1S82-8

MATERIALS AND METHODSIn our Prosthodontics Dept Sapienza University of Rome from November 2004 to October 2007 we selected 24 patients (both sexes 42 years mean age wellhealthy no smokers) having maxillary and mandibular partial atrophic alveolar ridges and asking for implant supported prostheses We inserted 78 rot ormer PBRimplants (TMIreg Pressing Dental San Marino Italy) together with a bone graft material (BioOss Geistlich) Minimum implant diameter was 375mm and minimumlength was 105mm The primary implant stability was estimated by RFA When the ISQ resulted ge 57 value in the 2nd stage surgery they were early loaded (15months from surgery) The ISQ values were subsequently estimated every month until the 6th month then at 9 and 12 months The endoral X-rays have beenexecuted to 0 2 6 9 and 12 months

RESULTSIn the 2nd stage surgery a complete bone defect filling was observed in all the cases except one that was characterized by partial bone defect filling (greater than50 and without flap dehiscence) The most significant ISQ values increase was observed in the first 2 months a further ISQ value increasing was observed until the3rd-4th month and successively the ISQ values levelled on constant shares At the end of the second month just 6 implants (77) of 5 different patients didnrsquot show57 ISQ value Among these implants 2 showed clinical mobility (M) in early time (third and fourth month) and they were removed and indicated like failures Theendoral X-ray didnrsquot show any change of the marginal bone level Clinical and X-ray results analized with T-Student test were statistically significant (Plt0005)

CONCLUSIONSThe timing of bone tissue healing around TMI implants overlap timing of a simple fracture of the jaw bones These results showed as early loading of PBR implants

inserted together bone grafts seems to be a valid technique to restore atrophic alveolar ridges shortening healing time and having quicker clinical case resolution

689

87th General Session amp Exhibition of the IADRMiami Florida - April 1-4 2009

CLINICAL AND HISTOLOGICAL EVALUATION OF ATROPHIC MAXILLARY RIDGES IMPLANT REHABILITATIONI VOZZA S ROSSI AM CARPIO E NICOLINI and G POMPA

Dental School Prosthodontics Department ldquoLa Sapienzardquo University Rome Italy

INTRODUCTION

The latest and new indications about implant surgery and the constant introduction on the market of new components and methodologies go hand in handwith the ever-increasing demand from our patients for a quicker and quicker functional rehabilitation Primary Bone Regeneration (PBR) is a mechanism ofnatural bone healing leading to consolidation of two bone segments in 6 weeks In Implant-Prosthodontics PBR implants let the patient have quickerprosthetic rehabilitation also in case of severe bone atrophy and after guided bone regeneration In fact with PBR implants itrsquos possible to load them justafter 45 days from implants insertion This depends on primary intention bone healing with direct formation of bone tissue close in contact with implants andwithout interposition of connective tissue The aim of this study was to evaluate early loading of PBR (Primary Bone Regeneration) implants insertedtogether with bone grafts in atrophic maxillary ridges

REFERENCES

Attard NJ Zarb GA Immediate and early implant loading protocols a review of clinical studies J Prosthet Dent 2005 Sep 94 (3) 242-58

Brochu JF Anderson JD Zarb GA The influence of early loading on bony crest height and stability a pilot study Int J Prosthodont 2005 Nov-Dec 18 (6) 506-12

Cornelini R Barone A Covani U Connective tissue grafts in postextraction implants with immediate restoration a prospective controlled clinical study Pract Proced Aesthet Dent 2008 Jul20(6)337-43

Esposito M Grusovin MG Achille H Coulthard P Worthington HV Interventions for replacing missing teeth different times for loading dental implants Cochrane Database Syst Rev 2009 Jan 21(1)CD003878

Friberg B Raghoebar GM A 5-year prospective multicenter study on 1-stage smooth-surface Branemark System implants with early loading in edentulous mandibles Int J Oral Maxillofac Implants 2008 May-Jun23(3)481-6

Malchiodi L Quaranta A Scarano A Quaranta M Jaw reconstruction with grafted autologous bone early insertion of osseointegrated implants and early prosthetic loading J Oral Maxillofac Surg 2006 Aug64(8)1190-8

Mannai C Early implant loading in severely resorbed maxilla using xenograft autograft and platelet-rich plasma in 97 patients J Oral Maxillofac Surg 2006 Sep64(9)1420-6

Lai HC Zhang ZY Zhuang LF Wang F Liu X Pu YP Early loading of ITI implants supporting maxillary fixed full-arch prostheses Clin Oral Implants Res 2008 Nov19(11)1129-34

Piattelli A Corigliano M Scarano A Quaranta M Bone reactions to early occlusal loading of two-stage titanium plasma-sprayed implants a pilot study in monkeys Int J Periodontics Restorative Dent 1997 Apr17(2)162-9

Sennerby L Gottlow J Clinical outcome of immediatelyearly loading of dental implants A literature review of recent controlled prospective clinical studies Aust Dent J 2008 Jun53 Suppl 1S82-8

MATERIALS AND METHODSIn our Prosthodontics Dept Sapienza University of Rome from November 2004 to June 2007 a sinus lifting was performed in 8 patients (56 years mean agemale gender initial bone height of 15 -2 mm and bone width of 5 mm) asking for a fixed implant-supported rehabilitation They signed an informed consentIn every patient 2root former PBR implants (TMIreg Pressing Dental San Marino Italy) having 325 diameter and 105mm length were inserted together witha bone graft material (Physiograftreg Ghimas) 25 months after maxillary sinus augmentation one of the implants was retrieved and processed forundecalcified histology while the other one was loaded The endoral X-rays have been executed to 0 2 6 9 and 12 months

RESULTSFrom the histomorphometric analysis the graft material residuals accounted for the 4698 of the bioptical volume marrow spaces for the 1876 and bonefor the 3287 (new bone 2262 native bone 1025) Well-mineralized regenerated bone with lamellar parallel-fibred structure and Haversian systemssurrounded the residual graft material particles The measured BIC amounted to 1694 No connective tissue was observed at the implant boundary surfaceFrom clinical point of view there was no implant failure at the 2nd stage neither mobility nor bleeding on probing The endoral X-rays showed a completebone defect filling and no change of the marginal bone level was observed Clinical and X-ray results analized with T-Student test were statistically significant

(Plt0005) CONCLUSIONSThese results showed as early loading of PBR implants inserted together with bone grafts appears to be suitable for maxillary sinus floor augmentation alsoin critical condition as minimal vertical bone height and shorter healing time

3389

Objectives The aim of this study was to obtain immediate bone reparation in only 6 wks and to predict primary bone apposition

without intermediate growth of the connective tissue

Methods We inserted 128 PBR (Primary Bone Reparation) implants (TMIreg Pressing Dental RSM) into 42 patients of both

genders aged between 29 and 68 yrs After 45 days 25 implants were removed from their sites carefully chosen so as not

to endanger either the final prosthesis plan or the patients health The removed samples were embedded in resin (Tecnovit

Kulzer) histologically prepared (EXAKT) and stained with hematoxylin eosin and methylene blue The same samples

were then examined histologically under an optical microscope (Zeiss and Leitz) at 50-100-200-400X

86th General Session and Exibition of the IADR ndash Metro Toronto Convention Centre Canada

Histologic evaluation of a PBR implant system study in manM CORIGLIANO1 S ROSSI2 AM CARPIO2 and S DI CARLO2

1International Academy of Implantoprosthesis and Osteoconnection Rome Italy 2University

of Rome Sapienza Italy

1 Schenk RK Histologie der Primarien Knocheilung Verh Dtsch ges pathol 1974 54 8-12

2 Corigliano M Vrespa G DrsquoAddona A Casolo F Impianto a guarigione primaria Dental Cadmos 1994 11 60-72

3 Piattelli A Paolantonio M Corigliano M Scarano A Immediate loading of titanium plasma-sprayed screw-shaped implants in man a clinical and histological report of two cases J Periodontol 199768591-

597

3 Corigliano M Barlattani A Gargari M Ottria L Andreana S La riparazione ossea primaria in implantoprotesi possibilitagrave tecnica ed applicazioni Quint Int 2002 910 359-370

4 Cooper LF Rahman A Moriarty J Chaffee N Sacco D Immediate mandibular rehabilitation with endosseous implants simultaneous extraction implant placement and loadingInt J Oral Maxillofac

Implants 200217(4)517-25

5 Gherlone E Albano F Vrespa G Falegatti G Capuano A Carico immediato su impianti post estrattivi immediati Implantologia 2004125-37

6 Forabosco A et al Impianti postestrattivi a carico immediato Doctor Os 200617(1)188-190

6

TMI reg Implant System is composed by

Fig1 Pilot Drill

Fig2 Osteotom ldquo UNICArdquo

Fig3 Implant

2

Results The quantity and the quality of the bone observed histologically

in connection with the radicular titanium prostheses following PBR

registered complete growth The BIC (Bone Implant Contact) measured

all around the removed implants averaged 85 Further there were no

necrotic zones associated with the resorption or substitution with

connective fibrous tissue

Conclusions Our histologic analysis demonstrates that the PBR

implant system is without doubt reliable Actually it permits a

great deal of bone to support the progressive load of dental

prostheses

2

Histological images coloured

with hematoxylineosin and

methilene blue

Surgycal phases

1 Drilling

2 Osteotomy with ldquoUNICArdquo

3 Radicular prostheses

insert

85th General Session amp Exhibition of the IADRNew Orleans 21-24 March 2007

EARLY LOADED IMPLANT SUPPORTED OVERDENTURE 3-YEAR FOLLOW-UP EVALUATIONS ROSSI I VOZZA A GIOVANNETTI MP BASILE S DI CARLO

Dental School Prosthodontics Department ldquoLa Sapienzardquo University Rome Italy

INTRODUCTION

Primary Bone Reparation PBR is a mechanism of natural bone healing determining consolidation of two bone segments in 6 weeks In Implantology PBR implantsconsent to patient having prosthetic rehabilitation briefly because it is possible to load them just in 45 days form fixture insertion This is possible thanking to firstintention bone healing with direct formation of bone tissue in contact with implant and without interposition of connective tissue Times of tissue reparationaround implants are superimposable to times of a simple fracture of maxilla The aim of this study was to evaluate perimplant marginal bone level on early loadedimplants supporting overdenture

REFERENCES

Attard NJ Zarb GA Immediate and early implant loading protocols a literature review of clinical studies J Prosthet Dent 200594(3)242-58

Brochu JF Anderson JD Zarb GA The influence of early loading on bony crest height and stability a pilot study Int J Prosthodont 200518(6)506-12

Chiapasco M Early and immediate restoration and loading of implants in completely edentulous patients Int J Oral Maxillofac Implants 200419 Suppl76-91

Mericske-Stern R Oetterli M Kiener P Mericske E A follow-up study of maxillary implants supporting an overdenture clinical and radiographic results Int J Oral Maxillofac Implants 200217(5)678-86

Misch CE Degidi M 5-year prospective study of immediateearly loading of fixed prostheses in completely edentulous jaw with a bone quality-based implant system Clin Implant Dent Relat Res 20035(1)17-28

Payne AG Tawse-Smith A Thomson WM Duncan WD Kumara R One-stage surgery and early loading of three implants for maxillary overdenture a 1-year report Clin Implant Dent Relat Res 20046(2)61-74

Raghoebar GM Friberg B Grunert I Hobkirk JA Tepper G Wendelhag I 3-year prospective multicenter study on one-stage implant surgery and early loading in the edentulous mandible Clin Implant Dent Relat Res 20035(1)39-46

Raghoebar GM Schoen P Meijer HJ Stellingsma K Vissink A Early loading of endosseous implants in the augmented maxilla a 1-year prospective study Clin Oral Implants Res 200314(6)697-702

MATERIALS AND METHODSIn our Prosthodontics Depratment La Sapienza University of Rome from May 2001 to December November 2003 we selected 30 patients (both sexes 49 yearsmean age no smokers) having maxillary total edentulism and asking for fixed prosthetic rehabilitation We inserted 128 root former implants (TMI PressingDental San Marino) they were early loaded after 45 days Minimum diameter was 42mm and minimum length was 13mm Before cementation of each finalrestoration we executed a periapical X-ray using a digital X-ray system (Den Optix Gendex Dentsply Int) The X-ray controls were executed after 1-3-6-9-12months and then yearly

RESULTSMarginal bone levels were evaluated by 2 different operators using a computerised measure system (Vix-win 2000 Gendex Dentsply Int) During the first yearthere was 028mm mean bone loss while during the next two years it was 017mm according to Albrektsson and Zarb implant success criteria (lt1mm during thefirst year and lt02mm during next years) X-ray results analized with T-Student test were statistically significant (Plt0005)

CONCLUSIONSParameters for the valuation of Implantology success have to be established before discussing about obtained results by this experimentation On the basis ofthis osseointegration definition clinical studies have to be purposed to survey the implant stability under functional loading In this order itrsquos necessary thatduring periodic controls implant mobility has to be evaluated and radiographic examinations have to be executed in a reproducible way for determining the stateof perimplant bone tissue health The implant success is evaluated on the following criteria by Albrektsson and Zarb 1) the not splinted implant has to be clinicallyimmovable 2) on the X-ray no perimplant radiotranslucency marks have to be present 3) vertical bone loss has to be lower than 1mm during the first year ofloading and lower than 02mm yearly in the following years 4) each implant has to be without marks or persistent andor not reversible symptoms for examplepain infections neuropathies paresthesis or penetration into the mandibular canal 5)prosthetic restoration has to satisfy function and aesthetics On thesepreliminary remarks in the anterior upper and lower sectors it should occur a success rate of 90 and 85 on long time respectively after 5 and 10 years in theposterior sectors these percentages have to be about 85 after 5 years and 80 after 10 years The obtained results from this experimentation are encouragingfully respecting implant success criteria by Albrektsson and Zarb These results showed as early loaded implants supporting overdenture are clinically andradiographically well osseointegrated

516

Introduction ndash It has been clearly proved by Ludwig through Fourierrsquos analysis [ Ludwig1993] that ultraweak signals are easly recognazed compared with the background noise if they present a patternthe signals the living matter is able to recognized among a variety of interferential signals are highly complex that is they are made up of different frequency bands Infact the complex signal reaches the biological system as a repetition of weak signals but connected among them in a fixed pattern and it is the

repetition of this pattern that distinguish the ldquotrue signalrdquo from the background noise The action of the CMF identifies as the sum of the effects of superimposed continous and pulsed magnetic fields on biological systemsOn the bone tissue is possible to obtain a neo-osteomorphogenesis increasing the gene expression of the morphogenetic proteins

and modulating the osteoclastogenetic proteins action The same results we can obtain on soft tissue The target of our clinical trial ldquoin vivordquo can demonstrate the effects of Combined Magnetic Field on the bone tissue in oral implantology

Methods 458 patients of both genders aged between 35 and 72 yrs underwent implant surgery associated with GBR according to the protocol of the PBR implant system 1024

fixtures were inserted by means of the TMIreg implant system (Pressing Dental RSM) The MET and CMF (MFI Italy) were applied to all patients for 74 days

Osteogenesis was radiologically controlled after 30 60 90 and 120 days All implants were loaded in 120 days

86th General Session and Exibition of the IADR ndash Metro Toronto Convention Centre Canada

Osteomorphogenesis biostimulated by CMF Combined Magnetic Fields M Corigliano1 S Rossi2 F Crescentini2 A Giovanetti2 S Di Carlo2

1International Academy of Implantoprosthesis and Osteoconnection Rome Italy 2 University of Rome Sapienza Italy

Induttori della TME

applicati

CMF-OS amp BR (1) TME (2) MFI Production

1

2

Stimulated morphogenetic proteins gene expression

and modulation of osteoclastogenesis by CMF induction

FGF-2 FGFai AngiopoietinTrombopoietin EGFConnexin 43 Cox-1 e Cox-2 BMP-2 BMP-4 c-myc e c-fosG-proteinCollagen I osteocalcin

Signal Molecules Erk frac12CREBIRS-1eNOS Cytokine IL1 TNFαTNFβTGkαTGFβPDGFIGF-1IGF-

2FGF Osteoclastogenesis Modulators OPGRank RANKL

M-CSFPGE2 EnzymesCytocrome-OssidaseNaK-ATPase hsp70

ornithine decarboxilase adinylate-cyclase protein kinase C

Densification Proteins and ions Osteocalcin Procollagenionized calcium ALPEstrogen-receptor system

Proteoglycans Collagen IIITP1 TPIII

Results All those who underwent implant therapy with GBR and were treated with the combination of MET and CMF showed complete mineralization in a shorter period of time than that commonly reported in these

cases

Conclusions The combined use of MET and CMF together with the PBR implant system can ameliorate and strengthen the physiological mechanisms of bone reparation

Materials CMF-OS ampBR Inductor of CMF multifrequential and presequential with continous magnetic fields Frequency from 1 to 80Hz Amplitude from 1

a 100μT and field amplifierconcentrator TME inductor of bifrequential fieldAmplitude from 5 a 50G for domiciliary use

Induction Method 6 inductions with CMF every 3 days for 12 mindie and TME domiciliary 30min X 2die X 45 days( inductors MFI Italy)

1 2 3

Soft Tissues unsuccessfull gengivoplasty Fase1 date 11042007 (2)date 11182007 (3)12062007 CMF treated 6 X 12 min induction sequenced every 3days

Ludwig W Magneitc Field Therapy In Alternative Medicine Future Medicine Publishing Washington (1993) McLeod BR Liboff AR Dynamic characteristics of membrane ions in multifield configurations of low-frequency

electromagnetic radiationBioelectromagnetics 19867(2)177-89

Blank M Goodman R Electromagnetic fields may act directly on DNADepartment of Physiology Columbia University New York New York 10032 USA mb32columbiaedu J Cell Biochem 1999 Dec 175(3)369-74

Fig1 Dental-Scan Fig2 Implants Fig3 RX results After 45 days

CMF-TME therapy 1 2 3

Autore di numerose pubblicazioni in campo scientifico nazionale e internazionale

87th General Session amp Exhibition of the IADRMiami Florida - April 1-4 2009

CLINICAL EVALUATION OF OSSEOINTEGRATION OF IMPLANTS PLACED IN GRAFTED BONEI VOZZA S ROSSI L PICCOLI and M QUARANTA

Dental School Prosthodontics Department ldquoLa Sapienzardquo University Rome Italy

INTRODUCTION

Primary Bone Regeneration (PBR) is a mechanism of natural bone healing leading to consolidation of two bone segments in 6 weeks In Implant-Prosthodontics

PBR implants let the patient have quicker prosthetic rehabilitation also in case of severe bone atrophy and after guided bone regeneration In fact with PBR implantsitrsquos possible to load them just after 45 days from implants insertion This depends on primary intention bone healing with direct formation of bone tissue close incontact with implants and without interposition of connective tissue The aim of this study was to evaluate osseointegration in early loaded PBR implants insertedtogether with bone grafts in atrophic alveolar ridges

REFERENCES

Cornelini R Barone A Covani U Connective tissue grafts in postextraction implants with immediate restoration a prospective controlled clinical study Pract Proced Aesthet Dent 2008 Jul20(6)337-43

Esposito M Grusovin MG Achille H Coulthard P Worthington HV Interventions for replacing missing teeth different times for loading dental implants Cochrane Database Syst Rev 2009 Jan 21(1)CD003878

Friberg B Raghoebar GM et al A 5-year prospective multicenter study on 1-stage smooth-surface Branemark System implants with early loading in edentulous mandibles Int J Oral Maxillofac Implants 2008 May23(3)481-6

Lai HC Zhang ZY Zhuang LF Wang F Liu X Pu YP Early loading of ITI implants supporting maxillary fixed full-arch prostheses Clin Oral Implants Res 2008 Nov19(11)1129-34

Malchiodi L Quaranta A Scarano A Quaranta M Jaw reconstruction with grafted autologous bone early insertion of osseointegrated implants and early prosthetic loading J Oral Maxillofac Surg 2006 Aug64(8)1190-8

Mannai C Early implant loading in severely resorbed maxilla using xenograft autograft and platelet-rich plasma in 97 patients J Oral Maxillofac Surg 2006 Sep64(9)1420-6

Piattelli A Corigliano M Scarano A Quaranta M Bone reactions to early occlusal loading of two-stage titanium plasma-sprayed implants a pilot study in monkeys Int J Periodontics Restorative Dent 1997 Apr17(2)162-9

Sennerby L Gottlow J Clinical outcome of immediatelyearly loading of dental implants A literature review of recent controlled prospective clinical studies Aust Dent J 2008 Jun53 Suppl 1S82-8

MATERIALS AND METHODSIn our Prosthodontics Dept Sapienza University of Rome from November 2004 to October 2007 we selected 24 patients (both sexes 42 years mean age wellhealthy no smokers) having maxillary and mandibular partial atrophic alveolar ridges and asking for implant supported prostheses We inserted 78 rot ormer PBRimplants (TMIreg Pressing Dental San Marino Italy) together with a bone graft material (BioOss Geistlich) Minimum implant diameter was 375mm and minimumlength was 105mm The primary implant stability was estimated by RFA When the ISQ resulted ge 57 value in the 2nd stage surgery they were early loaded (15months from surgery) The ISQ values were subsequently estimated every month until the 6th month then at 9 and 12 months The endoral X-rays have beenexecuted to 0 2 6 9 and 12 months

RESULTSIn the 2nd stage surgery a complete bone defect filling was observed in all the cases except one that was characterized by partial bone defect filling (greater than50 and without flap dehiscence) The most significant ISQ values increase was observed in the first 2 months a further ISQ value increasing was observed until the3rd-4th month and successively the ISQ values levelled on constant shares At the end of the second month just 6 implants (77) of 5 different patients didnrsquot show57 ISQ value Among these implants 2 showed clinical mobility (M) in early time (third and fourth month) and they were removed and indicated like failures Theendoral X-ray didnrsquot show any change of the marginal bone level Clinical and X-ray results analized with T-Student test were statistically significant (Plt0005)

CONCLUSIONSThe timing of bone tissue healing around TMI implants overlap timing of a simple fracture of the jaw bones These results showed as early loading of PBR implants

inserted together bone grafts seems to be a valid technique to restore atrophic alveolar ridges shortening healing time and having quicker clinical case resolution

689

87th General Session amp Exhibition of the IADRMiami Florida - April 1-4 2009

CLINICAL AND HISTOLOGICAL EVALUATION OF ATROPHIC MAXILLARY RIDGES IMPLANT REHABILITATIONI VOZZA S ROSSI AM CARPIO E NICOLINI and G POMPA

Dental School Prosthodontics Department ldquoLa Sapienzardquo University Rome Italy

INTRODUCTION

The latest and new indications about implant surgery and the constant introduction on the market of new components and methodologies go hand in handwith the ever-increasing demand from our patients for a quicker and quicker functional rehabilitation Primary Bone Regeneration (PBR) is a mechanism ofnatural bone healing leading to consolidation of two bone segments in 6 weeks In Implant-Prosthodontics PBR implants let the patient have quickerprosthetic rehabilitation also in case of severe bone atrophy and after guided bone regeneration In fact with PBR implants itrsquos possible to load them justafter 45 days from implants insertion This depends on primary intention bone healing with direct formation of bone tissue close in contact with implants andwithout interposition of connective tissue The aim of this study was to evaluate early loading of PBR (Primary Bone Regeneration) implants insertedtogether with bone grafts in atrophic maxillary ridges

REFERENCES

Attard NJ Zarb GA Immediate and early implant loading protocols a review of clinical studies J Prosthet Dent 2005 Sep 94 (3) 242-58

Brochu JF Anderson JD Zarb GA The influence of early loading on bony crest height and stability a pilot study Int J Prosthodont 2005 Nov-Dec 18 (6) 506-12

Cornelini R Barone A Covani U Connective tissue grafts in postextraction implants with immediate restoration a prospective controlled clinical study Pract Proced Aesthet Dent 2008 Jul20(6)337-43

Esposito M Grusovin MG Achille H Coulthard P Worthington HV Interventions for replacing missing teeth different times for loading dental implants Cochrane Database Syst Rev 2009 Jan 21(1)CD003878

Friberg B Raghoebar GM A 5-year prospective multicenter study on 1-stage smooth-surface Branemark System implants with early loading in edentulous mandibles Int J Oral Maxillofac Implants 2008 May-Jun23(3)481-6

Malchiodi L Quaranta A Scarano A Quaranta M Jaw reconstruction with grafted autologous bone early insertion of osseointegrated implants and early prosthetic loading J Oral Maxillofac Surg 2006 Aug64(8)1190-8

Mannai C Early implant loading in severely resorbed maxilla using xenograft autograft and platelet-rich plasma in 97 patients J Oral Maxillofac Surg 2006 Sep64(9)1420-6

Lai HC Zhang ZY Zhuang LF Wang F Liu X Pu YP Early loading of ITI implants supporting maxillary fixed full-arch prostheses Clin Oral Implants Res 2008 Nov19(11)1129-34

Piattelli A Corigliano M Scarano A Quaranta M Bone reactions to early occlusal loading of two-stage titanium plasma-sprayed implants a pilot study in monkeys Int J Periodontics Restorative Dent 1997 Apr17(2)162-9

Sennerby L Gottlow J Clinical outcome of immediatelyearly loading of dental implants A literature review of recent controlled prospective clinical studies Aust Dent J 2008 Jun53 Suppl 1S82-8

MATERIALS AND METHODSIn our Prosthodontics Dept Sapienza University of Rome from November 2004 to June 2007 a sinus lifting was performed in 8 patients (56 years mean agemale gender initial bone height of 15 -2 mm and bone width of 5 mm) asking for a fixed implant-supported rehabilitation They signed an informed consentIn every patient 2root former PBR implants (TMIreg Pressing Dental San Marino Italy) having 325 diameter and 105mm length were inserted together witha bone graft material (Physiograftreg Ghimas) 25 months after maxillary sinus augmentation one of the implants was retrieved and processed forundecalcified histology while the other one was loaded The endoral X-rays have been executed to 0 2 6 9 and 12 months

RESULTSFrom the histomorphometric analysis the graft material residuals accounted for the 4698 of the bioptical volume marrow spaces for the 1876 and bonefor the 3287 (new bone 2262 native bone 1025) Well-mineralized regenerated bone with lamellar parallel-fibred structure and Haversian systemssurrounded the residual graft material particles The measured BIC amounted to 1694 No connective tissue was observed at the implant boundary surfaceFrom clinical point of view there was no implant failure at the 2nd stage neither mobility nor bleeding on probing The endoral X-rays showed a completebone defect filling and no change of the marginal bone level was observed Clinical and X-ray results analized with T-Student test were statistically significant

(Plt0005) CONCLUSIONSThese results showed as early loading of PBR implants inserted together with bone grafts appears to be suitable for maxillary sinus floor augmentation alsoin critical condition as minimal vertical bone height and shorter healing time

3389

Objectives The aim of this study was to obtain immediate bone reparation in only 6 wks and to predict primary bone apposition

without intermediate growth of the connective tissue

Methods We inserted 128 PBR (Primary Bone Reparation) implants (TMIreg Pressing Dental RSM) into 42 patients of both

genders aged between 29 and 68 yrs After 45 days 25 implants were removed from their sites carefully chosen so as not

to endanger either the final prosthesis plan or the patients health The removed samples were embedded in resin (Tecnovit

Kulzer) histologically prepared (EXAKT) and stained with hematoxylin eosin and methylene blue The same samples

were then examined histologically under an optical microscope (Zeiss and Leitz) at 50-100-200-400X

86th General Session and Exibition of the IADR ndash Metro Toronto Convention Centre Canada

Histologic evaluation of a PBR implant system study in manM CORIGLIANO1 S ROSSI2 AM CARPIO2 and S DI CARLO2

1International Academy of Implantoprosthesis and Osteoconnection Rome Italy 2University

of Rome Sapienza Italy

1 Schenk RK Histologie der Primarien Knocheilung Verh Dtsch ges pathol 1974 54 8-12

2 Corigliano M Vrespa G DrsquoAddona A Casolo F Impianto a guarigione primaria Dental Cadmos 1994 11 60-72

3 Piattelli A Paolantonio M Corigliano M Scarano A Immediate loading of titanium plasma-sprayed screw-shaped implants in man a clinical and histological report of two cases J Periodontol 199768591-

597

3 Corigliano M Barlattani A Gargari M Ottria L Andreana S La riparazione ossea primaria in implantoprotesi possibilitagrave tecnica ed applicazioni Quint Int 2002 910 359-370

4 Cooper LF Rahman A Moriarty J Chaffee N Sacco D Immediate mandibular rehabilitation with endosseous implants simultaneous extraction implant placement and loadingInt J Oral Maxillofac

Implants 200217(4)517-25

5 Gherlone E Albano F Vrespa G Falegatti G Capuano A Carico immediato su impianti post estrattivi immediati Implantologia 2004125-37

6 Forabosco A et al Impianti postestrattivi a carico immediato Doctor Os 200617(1)188-190

6

TMI reg Implant System is composed by

Fig1 Pilot Drill

Fig2 Osteotom ldquo UNICArdquo

Fig3 Implant

2

Results The quantity and the quality of the bone observed histologically

in connection with the radicular titanium prostheses following PBR

registered complete growth The BIC (Bone Implant Contact) measured

all around the removed implants averaged 85 Further there were no

necrotic zones associated with the resorption or substitution with

connective fibrous tissue

Conclusions Our histologic analysis demonstrates that the PBR

implant system is without doubt reliable Actually it permits a

great deal of bone to support the progressive load of dental

prostheses

2

Histological images coloured

with hematoxylineosin and

methilene blue

Surgycal phases

1 Drilling

2 Osteotomy with ldquoUNICArdquo

3 Radicular prostheses

insert

85th General Session amp Exhibition of the IADRNew Orleans 21-24 March 2007

EARLY LOADED IMPLANT SUPPORTED OVERDENTURE 3-YEAR FOLLOW-UP EVALUATIONS ROSSI I VOZZA A GIOVANNETTI MP BASILE S DI CARLO

Dental School Prosthodontics Department ldquoLa Sapienzardquo University Rome Italy

INTRODUCTION

Primary Bone Reparation PBR is a mechanism of natural bone healing determining consolidation of two bone segments in 6 weeks In Implantology PBR implantsconsent to patient having prosthetic rehabilitation briefly because it is possible to load them just in 45 days form fixture insertion This is possible thanking to firstintention bone healing with direct formation of bone tissue in contact with implant and without interposition of connective tissue Times of tissue reparationaround implants are superimposable to times of a simple fracture of maxilla The aim of this study was to evaluate perimplant marginal bone level on early loadedimplants supporting overdenture

REFERENCES

Attard NJ Zarb GA Immediate and early implant loading protocols a literature review of clinical studies J Prosthet Dent 200594(3)242-58

Brochu JF Anderson JD Zarb GA The influence of early loading on bony crest height and stability a pilot study Int J Prosthodont 200518(6)506-12

Chiapasco M Early and immediate restoration and loading of implants in completely edentulous patients Int J Oral Maxillofac Implants 200419 Suppl76-91

Mericske-Stern R Oetterli M Kiener P Mericske E A follow-up study of maxillary implants supporting an overdenture clinical and radiographic results Int J Oral Maxillofac Implants 200217(5)678-86

Misch CE Degidi M 5-year prospective study of immediateearly loading of fixed prostheses in completely edentulous jaw with a bone quality-based implant system Clin Implant Dent Relat Res 20035(1)17-28

Payne AG Tawse-Smith A Thomson WM Duncan WD Kumara R One-stage surgery and early loading of three implants for maxillary overdenture a 1-year report Clin Implant Dent Relat Res 20046(2)61-74

Raghoebar GM Friberg B Grunert I Hobkirk JA Tepper G Wendelhag I 3-year prospective multicenter study on one-stage implant surgery and early loading in the edentulous mandible Clin Implant Dent Relat Res 20035(1)39-46

Raghoebar GM Schoen P Meijer HJ Stellingsma K Vissink A Early loading of endosseous implants in the augmented maxilla a 1-year prospective study Clin Oral Implants Res 200314(6)697-702

MATERIALS AND METHODSIn our Prosthodontics Depratment La Sapienza University of Rome from May 2001 to December November 2003 we selected 30 patients (both sexes 49 yearsmean age no smokers) having maxillary total edentulism and asking for fixed prosthetic rehabilitation We inserted 128 root former implants (TMI PressingDental San Marino) they were early loaded after 45 days Minimum diameter was 42mm and minimum length was 13mm Before cementation of each finalrestoration we executed a periapical X-ray using a digital X-ray system (Den Optix Gendex Dentsply Int) The X-ray controls were executed after 1-3-6-9-12months and then yearly

RESULTSMarginal bone levels were evaluated by 2 different operators using a computerised measure system (Vix-win 2000 Gendex Dentsply Int) During the first yearthere was 028mm mean bone loss while during the next two years it was 017mm according to Albrektsson and Zarb implant success criteria (lt1mm during thefirst year and lt02mm during next years) X-ray results analized with T-Student test were statistically significant (Plt0005)

CONCLUSIONSParameters for the valuation of Implantology success have to be established before discussing about obtained results by this experimentation On the basis ofthis osseointegration definition clinical studies have to be purposed to survey the implant stability under functional loading In this order itrsquos necessary thatduring periodic controls implant mobility has to be evaluated and radiographic examinations have to be executed in a reproducible way for determining the stateof perimplant bone tissue health The implant success is evaluated on the following criteria by Albrektsson and Zarb 1) the not splinted implant has to be clinicallyimmovable 2) on the X-ray no perimplant radiotranslucency marks have to be present 3) vertical bone loss has to be lower than 1mm during the first year ofloading and lower than 02mm yearly in the following years 4) each implant has to be without marks or persistent andor not reversible symptoms for examplepain infections neuropathies paresthesis or penetration into the mandibular canal 5)prosthetic restoration has to satisfy function and aesthetics On thesepreliminary remarks in the anterior upper and lower sectors it should occur a success rate of 90 and 85 on long time respectively after 5 and 10 years in theposterior sectors these percentages have to be about 85 after 5 years and 80 after 10 years The obtained results from this experimentation are encouragingfully respecting implant success criteria by Albrektsson and Zarb These results showed as early loaded implants supporting overdenture are clinically andradiographically well osseointegrated

516

Introduction ndash It has been clearly proved by Ludwig through Fourierrsquos analysis [ Ludwig1993] that ultraweak signals are easly recognazed compared with the background noise if they present a patternthe signals the living matter is able to recognized among a variety of interferential signals are highly complex that is they are made up of different frequency bands Infact the complex signal reaches the biological system as a repetition of weak signals but connected among them in a fixed pattern and it is the

repetition of this pattern that distinguish the ldquotrue signalrdquo from the background noise The action of the CMF identifies as the sum of the effects of superimposed continous and pulsed magnetic fields on biological systemsOn the bone tissue is possible to obtain a neo-osteomorphogenesis increasing the gene expression of the morphogenetic proteins

and modulating the osteoclastogenetic proteins action The same results we can obtain on soft tissue The target of our clinical trial ldquoin vivordquo can demonstrate the effects of Combined Magnetic Field on the bone tissue in oral implantology

Methods 458 patients of both genders aged between 35 and 72 yrs underwent implant surgery associated with GBR according to the protocol of the PBR implant system 1024

fixtures were inserted by means of the TMIreg implant system (Pressing Dental RSM) The MET and CMF (MFI Italy) were applied to all patients for 74 days

Osteogenesis was radiologically controlled after 30 60 90 and 120 days All implants were loaded in 120 days

86th General Session and Exibition of the IADR ndash Metro Toronto Convention Centre Canada

Osteomorphogenesis biostimulated by CMF Combined Magnetic Fields M Corigliano1 S Rossi2 F Crescentini2 A Giovanetti2 S Di Carlo2

1International Academy of Implantoprosthesis and Osteoconnection Rome Italy 2 University of Rome Sapienza Italy

Induttori della TME

applicati

CMF-OS amp BR (1) TME (2) MFI Production

1

2

Stimulated morphogenetic proteins gene expression

and modulation of osteoclastogenesis by CMF induction

FGF-2 FGFai AngiopoietinTrombopoietin EGFConnexin 43 Cox-1 e Cox-2 BMP-2 BMP-4 c-myc e c-fosG-proteinCollagen I osteocalcin

Signal Molecules Erk frac12CREBIRS-1eNOS Cytokine IL1 TNFαTNFβTGkαTGFβPDGFIGF-1IGF-

2FGF Osteoclastogenesis Modulators OPGRank RANKL

M-CSFPGE2 EnzymesCytocrome-OssidaseNaK-ATPase hsp70

ornithine decarboxilase adinylate-cyclase protein kinase C

Densification Proteins and ions Osteocalcin Procollagenionized calcium ALPEstrogen-receptor system

Proteoglycans Collagen IIITP1 TPIII

Results All those who underwent implant therapy with GBR and were treated with the combination of MET and CMF showed complete mineralization in a shorter period of time than that commonly reported in these

cases

Conclusions The combined use of MET and CMF together with the PBR implant system can ameliorate and strengthen the physiological mechanisms of bone reparation

Materials CMF-OS ampBR Inductor of CMF multifrequential and presequential with continous magnetic fields Frequency from 1 to 80Hz Amplitude from 1

a 100μT and field amplifierconcentrator TME inductor of bifrequential fieldAmplitude from 5 a 50G for domiciliary use

Induction Method 6 inductions with CMF every 3 days for 12 mindie and TME domiciliary 30min X 2die X 45 days( inductors MFI Italy)

1 2 3

Soft Tissues unsuccessfull gengivoplasty Fase1 date 11042007 (2)date 11182007 (3)12062007 CMF treated 6 X 12 min induction sequenced every 3days

Ludwig W Magneitc Field Therapy In Alternative Medicine Future Medicine Publishing Washington (1993) McLeod BR Liboff AR Dynamic characteristics of membrane ions in multifield configurations of low-frequency

electromagnetic radiationBioelectromagnetics 19867(2)177-89

Blank M Goodman R Electromagnetic fields may act directly on DNADepartment of Physiology Columbia University New York New York 10032 USA mb32columbiaedu J Cell Biochem 1999 Dec 175(3)369-74

Fig1 Dental-Scan Fig2 Implants Fig3 RX results After 45 days

CMF-TME therapy 1 2 3

87th General Session amp Exhibition of the IADRMiami Florida - April 1-4 2009

CLINICAL EVALUATION OF OSSEOINTEGRATION OF IMPLANTS PLACED IN GRAFTED BONEI VOZZA S ROSSI L PICCOLI and M QUARANTA

Dental School Prosthodontics Department ldquoLa Sapienzardquo University Rome Italy

INTRODUCTION

Primary Bone Regeneration (PBR) is a mechanism of natural bone healing leading to consolidation of two bone segments in 6 weeks In Implant-Prosthodontics

PBR implants let the patient have quicker prosthetic rehabilitation also in case of severe bone atrophy and after guided bone regeneration In fact with PBR implantsitrsquos possible to load them just after 45 days from implants insertion This depends on primary intention bone healing with direct formation of bone tissue close incontact with implants and without interposition of connective tissue The aim of this study was to evaluate osseointegration in early loaded PBR implants insertedtogether with bone grafts in atrophic alveolar ridges

REFERENCES

Cornelini R Barone A Covani U Connective tissue grafts in postextraction implants with immediate restoration a prospective controlled clinical study Pract Proced Aesthet Dent 2008 Jul20(6)337-43

Esposito M Grusovin MG Achille H Coulthard P Worthington HV Interventions for replacing missing teeth different times for loading dental implants Cochrane Database Syst Rev 2009 Jan 21(1)CD003878

Friberg B Raghoebar GM et al A 5-year prospective multicenter study on 1-stage smooth-surface Branemark System implants with early loading in edentulous mandibles Int J Oral Maxillofac Implants 2008 May23(3)481-6

Lai HC Zhang ZY Zhuang LF Wang F Liu X Pu YP Early loading of ITI implants supporting maxillary fixed full-arch prostheses Clin Oral Implants Res 2008 Nov19(11)1129-34

Malchiodi L Quaranta A Scarano A Quaranta M Jaw reconstruction with grafted autologous bone early insertion of osseointegrated implants and early prosthetic loading J Oral Maxillofac Surg 2006 Aug64(8)1190-8

Mannai C Early implant loading in severely resorbed maxilla using xenograft autograft and platelet-rich plasma in 97 patients J Oral Maxillofac Surg 2006 Sep64(9)1420-6

Piattelli A Corigliano M Scarano A Quaranta M Bone reactions to early occlusal loading of two-stage titanium plasma-sprayed implants a pilot study in monkeys Int J Periodontics Restorative Dent 1997 Apr17(2)162-9

Sennerby L Gottlow J Clinical outcome of immediatelyearly loading of dental implants A literature review of recent controlled prospective clinical studies Aust Dent J 2008 Jun53 Suppl 1S82-8

MATERIALS AND METHODSIn our Prosthodontics Dept Sapienza University of Rome from November 2004 to October 2007 we selected 24 patients (both sexes 42 years mean age wellhealthy no smokers) having maxillary and mandibular partial atrophic alveolar ridges and asking for implant supported prostheses We inserted 78 rot ormer PBRimplants (TMIreg Pressing Dental San Marino Italy) together with a bone graft material (BioOss Geistlich) Minimum implant diameter was 375mm and minimumlength was 105mm The primary implant stability was estimated by RFA When the ISQ resulted ge 57 value in the 2nd stage surgery they were early loaded (15months from surgery) The ISQ values were subsequently estimated every month until the 6th month then at 9 and 12 months The endoral X-rays have beenexecuted to 0 2 6 9 and 12 months

RESULTSIn the 2nd stage surgery a complete bone defect filling was observed in all the cases except one that was characterized by partial bone defect filling (greater than50 and without flap dehiscence) The most significant ISQ values increase was observed in the first 2 months a further ISQ value increasing was observed until the3rd-4th month and successively the ISQ values levelled on constant shares At the end of the second month just 6 implants (77) of 5 different patients didnrsquot show57 ISQ value Among these implants 2 showed clinical mobility (M) in early time (third and fourth month) and they were removed and indicated like failures Theendoral X-ray didnrsquot show any change of the marginal bone level Clinical and X-ray results analized with T-Student test were statistically significant (Plt0005)

CONCLUSIONSThe timing of bone tissue healing around TMI implants overlap timing of a simple fracture of the jaw bones These results showed as early loading of PBR implants

inserted together bone grafts seems to be a valid technique to restore atrophic alveolar ridges shortening healing time and having quicker clinical case resolution

689

87th General Session amp Exhibition of the IADRMiami Florida - April 1-4 2009

CLINICAL AND HISTOLOGICAL EVALUATION OF ATROPHIC MAXILLARY RIDGES IMPLANT REHABILITATIONI VOZZA S ROSSI AM CARPIO E NICOLINI and G POMPA

Dental School Prosthodontics Department ldquoLa Sapienzardquo University Rome Italy

INTRODUCTION

The latest and new indications about implant surgery and the constant introduction on the market of new components and methodologies go hand in handwith the ever-increasing demand from our patients for a quicker and quicker functional rehabilitation Primary Bone Regeneration (PBR) is a mechanism ofnatural bone healing leading to consolidation of two bone segments in 6 weeks In Implant-Prosthodontics PBR implants let the patient have quickerprosthetic rehabilitation also in case of severe bone atrophy and after guided bone regeneration In fact with PBR implants itrsquos possible to load them justafter 45 days from implants insertion This depends on primary intention bone healing with direct formation of bone tissue close in contact with implants andwithout interposition of connective tissue The aim of this study was to evaluate early loading of PBR (Primary Bone Regeneration) implants insertedtogether with bone grafts in atrophic maxillary ridges

REFERENCES

Attard NJ Zarb GA Immediate and early implant loading protocols a review of clinical studies J Prosthet Dent 2005 Sep 94 (3) 242-58

Brochu JF Anderson JD Zarb GA The influence of early loading on bony crest height and stability a pilot study Int J Prosthodont 2005 Nov-Dec 18 (6) 506-12

Cornelini R Barone A Covani U Connective tissue grafts in postextraction implants with immediate restoration a prospective controlled clinical study Pract Proced Aesthet Dent 2008 Jul20(6)337-43

Esposito M Grusovin MG Achille H Coulthard P Worthington HV Interventions for replacing missing teeth different times for loading dental implants Cochrane Database Syst Rev 2009 Jan 21(1)CD003878

Friberg B Raghoebar GM A 5-year prospective multicenter study on 1-stage smooth-surface Branemark System implants with early loading in edentulous mandibles Int J Oral Maxillofac Implants 2008 May-Jun23(3)481-6

Malchiodi L Quaranta A Scarano A Quaranta M Jaw reconstruction with grafted autologous bone early insertion of osseointegrated implants and early prosthetic loading J Oral Maxillofac Surg 2006 Aug64(8)1190-8

Mannai C Early implant loading in severely resorbed maxilla using xenograft autograft and platelet-rich plasma in 97 patients J Oral Maxillofac Surg 2006 Sep64(9)1420-6

Lai HC Zhang ZY Zhuang LF Wang F Liu X Pu YP Early loading of ITI implants supporting maxillary fixed full-arch prostheses Clin Oral Implants Res 2008 Nov19(11)1129-34

Piattelli A Corigliano M Scarano A Quaranta M Bone reactions to early occlusal loading of two-stage titanium plasma-sprayed implants a pilot study in monkeys Int J Periodontics Restorative Dent 1997 Apr17(2)162-9

Sennerby L Gottlow J Clinical outcome of immediatelyearly loading of dental implants A literature review of recent controlled prospective clinical studies Aust Dent J 2008 Jun53 Suppl 1S82-8

MATERIALS AND METHODSIn our Prosthodontics Dept Sapienza University of Rome from November 2004 to June 2007 a sinus lifting was performed in 8 patients (56 years mean agemale gender initial bone height of 15 -2 mm and bone width of 5 mm) asking for a fixed implant-supported rehabilitation They signed an informed consentIn every patient 2root former PBR implants (TMIreg Pressing Dental San Marino Italy) having 325 diameter and 105mm length were inserted together witha bone graft material (Physiograftreg Ghimas) 25 months after maxillary sinus augmentation one of the implants was retrieved and processed forundecalcified histology while the other one was loaded The endoral X-rays have been executed to 0 2 6 9 and 12 months

RESULTSFrom the histomorphometric analysis the graft material residuals accounted for the 4698 of the bioptical volume marrow spaces for the 1876 and bonefor the 3287 (new bone 2262 native bone 1025) Well-mineralized regenerated bone with lamellar parallel-fibred structure and Haversian systemssurrounded the residual graft material particles The measured BIC amounted to 1694 No connective tissue was observed at the implant boundary surfaceFrom clinical point of view there was no implant failure at the 2nd stage neither mobility nor bleeding on probing The endoral X-rays showed a completebone defect filling and no change of the marginal bone level was observed Clinical and X-ray results analized with T-Student test were statistically significant

(Plt0005) CONCLUSIONSThese results showed as early loading of PBR implants inserted together with bone grafts appears to be suitable for maxillary sinus floor augmentation alsoin critical condition as minimal vertical bone height and shorter healing time

3389

Objectives The aim of this study was to obtain immediate bone reparation in only 6 wks and to predict primary bone apposition

without intermediate growth of the connective tissue

Methods We inserted 128 PBR (Primary Bone Reparation) implants (TMIreg Pressing Dental RSM) into 42 patients of both

genders aged between 29 and 68 yrs After 45 days 25 implants were removed from their sites carefully chosen so as not

to endanger either the final prosthesis plan or the patients health The removed samples were embedded in resin (Tecnovit

Kulzer) histologically prepared (EXAKT) and stained with hematoxylin eosin and methylene blue The same samples

were then examined histologically under an optical microscope (Zeiss and Leitz) at 50-100-200-400X

86th General Session and Exibition of the IADR ndash Metro Toronto Convention Centre Canada

Histologic evaluation of a PBR implant system study in manM CORIGLIANO1 S ROSSI2 AM CARPIO2 and S DI CARLO2

1International Academy of Implantoprosthesis and Osteoconnection Rome Italy 2University

of Rome Sapienza Italy

1 Schenk RK Histologie der Primarien Knocheilung Verh Dtsch ges pathol 1974 54 8-12

2 Corigliano M Vrespa G DrsquoAddona A Casolo F Impianto a guarigione primaria Dental Cadmos 1994 11 60-72

3 Piattelli A Paolantonio M Corigliano M Scarano A Immediate loading of titanium plasma-sprayed screw-shaped implants in man a clinical and histological report of two cases J Periodontol 199768591-

597

3 Corigliano M Barlattani A Gargari M Ottria L Andreana S La riparazione ossea primaria in implantoprotesi possibilitagrave tecnica ed applicazioni Quint Int 2002 910 359-370

4 Cooper LF Rahman A Moriarty J Chaffee N Sacco D Immediate mandibular rehabilitation with endosseous implants simultaneous extraction implant placement and loadingInt J Oral Maxillofac

Implants 200217(4)517-25

5 Gherlone E Albano F Vrespa G Falegatti G Capuano A Carico immediato su impianti post estrattivi immediati Implantologia 2004125-37

6 Forabosco A et al Impianti postestrattivi a carico immediato Doctor Os 200617(1)188-190

6

TMI reg Implant System is composed by

Fig1 Pilot Drill

Fig2 Osteotom ldquo UNICArdquo

Fig3 Implant

2

Results The quantity and the quality of the bone observed histologically

in connection with the radicular titanium prostheses following PBR

registered complete growth The BIC (Bone Implant Contact) measured

all around the removed implants averaged 85 Further there were no

necrotic zones associated with the resorption or substitution with

connective fibrous tissue

Conclusions Our histologic analysis demonstrates that the PBR

implant system is without doubt reliable Actually it permits a

great deal of bone to support the progressive load of dental

prostheses

2

Histological images coloured

with hematoxylineosin and

methilene blue

Surgycal phases

1 Drilling

2 Osteotomy with ldquoUNICArdquo

3 Radicular prostheses

insert

85th General Session amp Exhibition of the IADRNew Orleans 21-24 March 2007

EARLY LOADED IMPLANT SUPPORTED OVERDENTURE 3-YEAR FOLLOW-UP EVALUATIONS ROSSI I VOZZA A GIOVANNETTI MP BASILE S DI CARLO

Dental School Prosthodontics Department ldquoLa Sapienzardquo University Rome Italy

INTRODUCTION

Primary Bone Reparation PBR is a mechanism of natural bone healing determining consolidation of two bone segments in 6 weeks In Implantology PBR implantsconsent to patient having prosthetic rehabilitation briefly because it is possible to load them just in 45 days form fixture insertion This is possible thanking to firstintention bone healing with direct formation of bone tissue in contact with implant and without interposition of connective tissue Times of tissue reparationaround implants are superimposable to times of a simple fracture of maxilla The aim of this study was to evaluate perimplant marginal bone level on early loadedimplants supporting overdenture

REFERENCES

Attard NJ Zarb GA Immediate and early implant loading protocols a literature review of clinical studies J Prosthet Dent 200594(3)242-58

Brochu JF Anderson JD Zarb GA The influence of early loading on bony crest height and stability a pilot study Int J Prosthodont 200518(6)506-12

Chiapasco M Early and immediate restoration and loading of implants in completely edentulous patients Int J Oral Maxillofac Implants 200419 Suppl76-91

Mericske-Stern R Oetterli M Kiener P Mericske E A follow-up study of maxillary implants supporting an overdenture clinical and radiographic results Int J Oral Maxillofac Implants 200217(5)678-86

Misch CE Degidi M 5-year prospective study of immediateearly loading of fixed prostheses in completely edentulous jaw with a bone quality-based implant system Clin Implant Dent Relat Res 20035(1)17-28

Payne AG Tawse-Smith A Thomson WM Duncan WD Kumara R One-stage surgery and early loading of three implants for maxillary overdenture a 1-year report Clin Implant Dent Relat Res 20046(2)61-74

Raghoebar GM Friberg B Grunert I Hobkirk JA Tepper G Wendelhag I 3-year prospective multicenter study on one-stage implant surgery and early loading in the edentulous mandible Clin Implant Dent Relat Res 20035(1)39-46

Raghoebar GM Schoen P Meijer HJ Stellingsma K Vissink A Early loading of endosseous implants in the augmented maxilla a 1-year prospective study Clin Oral Implants Res 200314(6)697-702

MATERIALS AND METHODSIn our Prosthodontics Depratment La Sapienza University of Rome from May 2001 to December November 2003 we selected 30 patients (both sexes 49 yearsmean age no smokers) having maxillary total edentulism and asking for fixed prosthetic rehabilitation We inserted 128 root former implants (TMI PressingDental San Marino) they were early loaded after 45 days Minimum diameter was 42mm and minimum length was 13mm Before cementation of each finalrestoration we executed a periapical X-ray using a digital X-ray system (Den Optix Gendex Dentsply Int) The X-ray controls were executed after 1-3-6-9-12months and then yearly

RESULTSMarginal bone levels were evaluated by 2 different operators using a computerised measure system (Vix-win 2000 Gendex Dentsply Int) During the first yearthere was 028mm mean bone loss while during the next two years it was 017mm according to Albrektsson and Zarb implant success criteria (lt1mm during thefirst year and lt02mm during next years) X-ray results analized with T-Student test were statistically significant (Plt0005)

CONCLUSIONSParameters for the valuation of Implantology success have to be established before discussing about obtained results by this experimentation On the basis ofthis osseointegration definition clinical studies have to be purposed to survey the implant stability under functional loading In this order itrsquos necessary thatduring periodic controls implant mobility has to be evaluated and radiographic examinations have to be executed in a reproducible way for determining the stateof perimplant bone tissue health The implant success is evaluated on the following criteria by Albrektsson and Zarb 1) the not splinted implant has to be clinicallyimmovable 2) on the X-ray no perimplant radiotranslucency marks have to be present 3) vertical bone loss has to be lower than 1mm during the first year ofloading and lower than 02mm yearly in the following years 4) each implant has to be without marks or persistent andor not reversible symptoms for examplepain infections neuropathies paresthesis or penetration into the mandibular canal 5)prosthetic restoration has to satisfy function and aesthetics On thesepreliminary remarks in the anterior upper and lower sectors it should occur a success rate of 90 and 85 on long time respectively after 5 and 10 years in theposterior sectors these percentages have to be about 85 after 5 years and 80 after 10 years The obtained results from this experimentation are encouragingfully respecting implant success criteria by Albrektsson and Zarb These results showed as early loaded implants supporting overdenture are clinically andradiographically well osseointegrated

516

Introduction ndash It has been clearly proved by Ludwig through Fourierrsquos analysis [ Ludwig1993] that ultraweak signals are easly recognazed compared with the background noise if they present a patternthe signals the living matter is able to recognized among a variety of interferential signals are highly complex that is they are made up of different frequency bands Infact the complex signal reaches the biological system as a repetition of weak signals but connected among them in a fixed pattern and it is the

repetition of this pattern that distinguish the ldquotrue signalrdquo from the background noise The action of the CMF identifies as the sum of the effects of superimposed continous and pulsed magnetic fields on biological systemsOn the bone tissue is possible to obtain a neo-osteomorphogenesis increasing the gene expression of the morphogenetic proteins

and modulating the osteoclastogenetic proteins action The same results we can obtain on soft tissue The target of our clinical trial ldquoin vivordquo can demonstrate the effects of Combined Magnetic Field on the bone tissue in oral implantology

Methods 458 patients of both genders aged between 35 and 72 yrs underwent implant surgery associated with GBR according to the protocol of the PBR implant system 1024

fixtures were inserted by means of the TMIreg implant system (Pressing Dental RSM) The MET and CMF (MFI Italy) were applied to all patients for 74 days

Osteogenesis was radiologically controlled after 30 60 90 and 120 days All implants were loaded in 120 days

86th General Session and Exibition of the IADR ndash Metro Toronto Convention Centre Canada

Osteomorphogenesis biostimulated by CMF Combined Magnetic Fields M Corigliano1 S Rossi2 F Crescentini2 A Giovanetti2 S Di Carlo2

1International Academy of Implantoprosthesis and Osteoconnection Rome Italy 2 University of Rome Sapienza Italy

Induttori della TME

applicati

CMF-OS amp BR (1) TME (2) MFI Production

1

2

Stimulated morphogenetic proteins gene expression

and modulation of osteoclastogenesis by CMF induction

FGF-2 FGFai AngiopoietinTrombopoietin EGFConnexin 43 Cox-1 e Cox-2 BMP-2 BMP-4 c-myc e c-fosG-proteinCollagen I osteocalcin

Signal Molecules Erk frac12CREBIRS-1eNOS Cytokine IL1 TNFαTNFβTGkαTGFβPDGFIGF-1IGF-

2FGF Osteoclastogenesis Modulators OPGRank RANKL

M-CSFPGE2 EnzymesCytocrome-OssidaseNaK-ATPase hsp70

ornithine decarboxilase adinylate-cyclase protein kinase C

Densification Proteins and ions Osteocalcin Procollagenionized calcium ALPEstrogen-receptor system

Proteoglycans Collagen IIITP1 TPIII

Results All those who underwent implant therapy with GBR and were treated with the combination of MET and CMF showed complete mineralization in a shorter period of time than that commonly reported in these

cases

Conclusions The combined use of MET and CMF together with the PBR implant system can ameliorate and strengthen the physiological mechanisms of bone reparation

Materials CMF-OS ampBR Inductor of CMF multifrequential and presequential with continous magnetic fields Frequency from 1 to 80Hz Amplitude from 1

a 100μT and field amplifierconcentrator TME inductor of bifrequential fieldAmplitude from 5 a 50G for domiciliary use

Induction Method 6 inductions with CMF every 3 days for 12 mindie and TME domiciliary 30min X 2die X 45 days( inductors MFI Italy)

1 2 3

Soft Tissues unsuccessfull gengivoplasty Fase1 date 11042007 (2)date 11182007 (3)12062007 CMF treated 6 X 12 min induction sequenced every 3days

Ludwig W Magneitc Field Therapy In Alternative Medicine Future Medicine Publishing Washington (1993) McLeod BR Liboff AR Dynamic characteristics of membrane ions in multifield configurations of low-frequency

electromagnetic radiationBioelectromagnetics 19867(2)177-89

Blank M Goodman R Electromagnetic fields may act directly on DNADepartment of Physiology Columbia University New York New York 10032 USA mb32columbiaedu J Cell Biochem 1999 Dec 175(3)369-74

Fig1 Dental-Scan Fig2 Implants Fig3 RX results After 45 days

CMF-TME therapy 1 2 3

87th General Session amp Exhibition of the IADRMiami Florida - April 1-4 2009

CLINICAL AND HISTOLOGICAL EVALUATION OF ATROPHIC MAXILLARY RIDGES IMPLANT REHABILITATIONI VOZZA S ROSSI AM CARPIO E NICOLINI and G POMPA

Dental School Prosthodontics Department ldquoLa Sapienzardquo University Rome Italy

INTRODUCTION

The latest and new indications about implant surgery and the constant introduction on the market of new components and methodologies go hand in handwith the ever-increasing demand from our patients for a quicker and quicker functional rehabilitation Primary Bone Regeneration (PBR) is a mechanism ofnatural bone healing leading to consolidation of two bone segments in 6 weeks In Implant-Prosthodontics PBR implants let the patient have quickerprosthetic rehabilitation also in case of severe bone atrophy and after guided bone regeneration In fact with PBR implants itrsquos possible to load them justafter 45 days from implants insertion This depends on primary intention bone healing with direct formation of bone tissue close in contact with implants andwithout interposition of connective tissue The aim of this study was to evaluate early loading of PBR (Primary Bone Regeneration) implants insertedtogether with bone grafts in atrophic maxillary ridges

REFERENCES

Attard NJ Zarb GA Immediate and early implant loading protocols a review of clinical studies J Prosthet Dent 2005 Sep 94 (3) 242-58

Brochu JF Anderson JD Zarb GA The influence of early loading on bony crest height and stability a pilot study Int J Prosthodont 2005 Nov-Dec 18 (6) 506-12

Cornelini R Barone A Covani U Connective tissue grafts in postextraction implants with immediate restoration a prospective controlled clinical study Pract Proced Aesthet Dent 2008 Jul20(6)337-43

Esposito M Grusovin MG Achille H Coulthard P Worthington HV Interventions for replacing missing teeth different times for loading dental implants Cochrane Database Syst Rev 2009 Jan 21(1)CD003878

Friberg B Raghoebar GM A 5-year prospective multicenter study on 1-stage smooth-surface Branemark System implants with early loading in edentulous mandibles Int J Oral Maxillofac Implants 2008 May-Jun23(3)481-6

Malchiodi L Quaranta A Scarano A Quaranta M Jaw reconstruction with grafted autologous bone early insertion of osseointegrated implants and early prosthetic loading J Oral Maxillofac Surg 2006 Aug64(8)1190-8

Mannai C Early implant loading in severely resorbed maxilla using xenograft autograft and platelet-rich plasma in 97 patients J Oral Maxillofac Surg 2006 Sep64(9)1420-6

Lai HC Zhang ZY Zhuang LF Wang F Liu X Pu YP Early loading of ITI implants supporting maxillary fixed full-arch prostheses Clin Oral Implants Res 2008 Nov19(11)1129-34

Piattelli A Corigliano M Scarano A Quaranta M Bone reactions to early occlusal loading of two-stage titanium plasma-sprayed implants a pilot study in monkeys Int J Periodontics Restorative Dent 1997 Apr17(2)162-9

Sennerby L Gottlow J Clinical outcome of immediatelyearly loading of dental implants A literature review of recent controlled prospective clinical studies Aust Dent J 2008 Jun53 Suppl 1S82-8

MATERIALS AND METHODSIn our Prosthodontics Dept Sapienza University of Rome from November 2004 to June 2007 a sinus lifting was performed in 8 patients (56 years mean agemale gender initial bone height of 15 -2 mm and bone width of 5 mm) asking for a fixed implant-supported rehabilitation They signed an informed consentIn every patient 2root former PBR implants (TMIreg Pressing Dental San Marino Italy) having 325 diameter and 105mm length were inserted together witha bone graft material (Physiograftreg Ghimas) 25 months after maxillary sinus augmentation one of the implants was retrieved and processed forundecalcified histology while the other one was loaded The endoral X-rays have been executed to 0 2 6 9 and 12 months

RESULTSFrom the histomorphometric analysis the graft material residuals accounted for the 4698 of the bioptical volume marrow spaces for the 1876 and bonefor the 3287 (new bone 2262 native bone 1025) Well-mineralized regenerated bone with lamellar parallel-fibred structure and Haversian systemssurrounded the residual graft material particles The measured BIC amounted to 1694 No connective tissue was observed at the implant boundary surfaceFrom clinical point of view there was no implant failure at the 2nd stage neither mobility nor bleeding on probing The endoral X-rays showed a completebone defect filling and no change of the marginal bone level was observed Clinical and X-ray results analized with T-Student test were statistically significant

(Plt0005) CONCLUSIONSThese results showed as early loading of PBR implants inserted together with bone grafts appears to be suitable for maxillary sinus floor augmentation alsoin critical condition as minimal vertical bone height and shorter healing time

3389

Objectives The aim of this study was to obtain immediate bone reparation in only 6 wks and to predict primary bone apposition

without intermediate growth of the connective tissue

Methods We inserted 128 PBR (Primary Bone Reparation) implants (TMIreg Pressing Dental RSM) into 42 patients of both

genders aged between 29 and 68 yrs After 45 days 25 implants were removed from their sites carefully chosen so as not

to endanger either the final prosthesis plan or the patients health The removed samples were embedded in resin (Tecnovit

Kulzer) histologically prepared (EXAKT) and stained with hematoxylin eosin and methylene blue The same samples

were then examined histologically under an optical microscope (Zeiss and Leitz) at 50-100-200-400X

86th General Session and Exibition of the IADR ndash Metro Toronto Convention Centre Canada

Histologic evaluation of a PBR implant system study in manM CORIGLIANO1 S ROSSI2 AM CARPIO2 and S DI CARLO2

1International Academy of Implantoprosthesis and Osteoconnection Rome Italy 2University

of Rome Sapienza Italy

1 Schenk RK Histologie der Primarien Knocheilung Verh Dtsch ges pathol 1974 54 8-12

2 Corigliano M Vrespa G DrsquoAddona A Casolo F Impianto a guarigione primaria Dental Cadmos 1994 11 60-72

3 Piattelli A Paolantonio M Corigliano M Scarano A Immediate loading of titanium plasma-sprayed screw-shaped implants in man a clinical and histological report of two cases J Periodontol 199768591-

597

3 Corigliano M Barlattani A Gargari M Ottria L Andreana S La riparazione ossea primaria in implantoprotesi possibilitagrave tecnica ed applicazioni Quint Int 2002 910 359-370

4 Cooper LF Rahman A Moriarty J Chaffee N Sacco D Immediate mandibular rehabilitation with endosseous implants simultaneous extraction implant placement and loadingInt J Oral Maxillofac

Implants 200217(4)517-25

5 Gherlone E Albano F Vrespa G Falegatti G Capuano A Carico immediato su impianti post estrattivi immediati Implantologia 2004125-37

6 Forabosco A et al Impianti postestrattivi a carico immediato Doctor Os 200617(1)188-190

6

TMI reg Implant System is composed by

Fig1 Pilot Drill

Fig2 Osteotom ldquo UNICArdquo

Fig3 Implant

2

Results The quantity and the quality of the bone observed histologically

in connection with the radicular titanium prostheses following PBR

registered complete growth The BIC (Bone Implant Contact) measured

all around the removed implants averaged 85 Further there were no

necrotic zones associated with the resorption or substitution with

connective fibrous tissue

Conclusions Our histologic analysis demonstrates that the PBR

implant system is without doubt reliable Actually it permits a

great deal of bone to support the progressive load of dental

prostheses

2

Histological images coloured

with hematoxylineosin and

methilene blue

Surgycal phases

1 Drilling

2 Osteotomy with ldquoUNICArdquo

3 Radicular prostheses

insert

85th General Session amp Exhibition of the IADRNew Orleans 21-24 March 2007

EARLY LOADED IMPLANT SUPPORTED OVERDENTURE 3-YEAR FOLLOW-UP EVALUATIONS ROSSI I VOZZA A GIOVANNETTI MP BASILE S DI CARLO

Dental School Prosthodontics Department ldquoLa Sapienzardquo University Rome Italy

INTRODUCTION

Primary Bone Reparation PBR is a mechanism of natural bone healing determining consolidation of two bone segments in 6 weeks In Implantology PBR implantsconsent to patient having prosthetic rehabilitation briefly because it is possible to load them just in 45 days form fixture insertion This is possible thanking to firstintention bone healing with direct formation of bone tissue in contact with implant and without interposition of connective tissue Times of tissue reparationaround implants are superimposable to times of a simple fracture of maxilla The aim of this study was to evaluate perimplant marginal bone level on early loadedimplants supporting overdenture

REFERENCES

Attard NJ Zarb GA Immediate and early implant loading protocols a literature review of clinical studies J Prosthet Dent 200594(3)242-58

Brochu JF Anderson JD Zarb GA The influence of early loading on bony crest height and stability a pilot study Int J Prosthodont 200518(6)506-12

Chiapasco M Early and immediate restoration and loading of implants in completely edentulous patients Int J Oral Maxillofac Implants 200419 Suppl76-91

Mericske-Stern R Oetterli M Kiener P Mericske E A follow-up study of maxillary implants supporting an overdenture clinical and radiographic results Int J Oral Maxillofac Implants 200217(5)678-86

Misch CE Degidi M 5-year prospective study of immediateearly loading of fixed prostheses in completely edentulous jaw with a bone quality-based implant system Clin Implant Dent Relat Res 20035(1)17-28

Payne AG Tawse-Smith A Thomson WM Duncan WD Kumara R One-stage surgery and early loading of three implants for maxillary overdenture a 1-year report Clin Implant Dent Relat Res 20046(2)61-74

Raghoebar GM Friberg B Grunert I Hobkirk JA Tepper G Wendelhag I 3-year prospective multicenter study on one-stage implant surgery and early loading in the edentulous mandible Clin Implant Dent Relat Res 20035(1)39-46

Raghoebar GM Schoen P Meijer HJ Stellingsma K Vissink A Early loading of endosseous implants in the augmented maxilla a 1-year prospective study Clin Oral Implants Res 200314(6)697-702

MATERIALS AND METHODSIn our Prosthodontics Depratment La Sapienza University of Rome from May 2001 to December November 2003 we selected 30 patients (both sexes 49 yearsmean age no smokers) having maxillary total edentulism and asking for fixed prosthetic rehabilitation We inserted 128 root former implants (TMI PressingDental San Marino) they were early loaded after 45 days Minimum diameter was 42mm and minimum length was 13mm Before cementation of each finalrestoration we executed a periapical X-ray using a digital X-ray system (Den Optix Gendex Dentsply Int) The X-ray controls were executed after 1-3-6-9-12months and then yearly

RESULTSMarginal bone levels were evaluated by 2 different operators using a computerised measure system (Vix-win 2000 Gendex Dentsply Int) During the first yearthere was 028mm mean bone loss while during the next two years it was 017mm according to Albrektsson and Zarb implant success criteria (lt1mm during thefirst year and lt02mm during next years) X-ray results analized with T-Student test were statistically significant (Plt0005)

CONCLUSIONSParameters for the valuation of Implantology success have to be established before discussing about obtained results by this experimentation On the basis ofthis osseointegration definition clinical studies have to be purposed to survey the implant stability under functional loading In this order itrsquos necessary thatduring periodic controls implant mobility has to be evaluated and radiographic examinations have to be executed in a reproducible way for determining the stateof perimplant bone tissue health The implant success is evaluated on the following criteria by Albrektsson and Zarb 1) the not splinted implant has to be clinicallyimmovable 2) on the X-ray no perimplant radiotranslucency marks have to be present 3) vertical bone loss has to be lower than 1mm during the first year ofloading and lower than 02mm yearly in the following years 4) each implant has to be without marks or persistent andor not reversible symptoms for examplepain infections neuropathies paresthesis or penetration into the mandibular canal 5)prosthetic restoration has to satisfy function and aesthetics On thesepreliminary remarks in the anterior upper and lower sectors it should occur a success rate of 90 and 85 on long time respectively after 5 and 10 years in theposterior sectors these percentages have to be about 85 after 5 years and 80 after 10 years The obtained results from this experimentation are encouragingfully respecting implant success criteria by Albrektsson and Zarb These results showed as early loaded implants supporting overdenture are clinically andradiographically well osseointegrated

516

Introduction ndash It has been clearly proved by Ludwig through Fourierrsquos analysis [ Ludwig1993] that ultraweak signals are easly recognazed compared with the background noise if they present a patternthe signals the living matter is able to recognized among a variety of interferential signals are highly complex that is they are made up of different frequency bands Infact the complex signal reaches the biological system as a repetition of weak signals but connected among them in a fixed pattern and it is the

repetition of this pattern that distinguish the ldquotrue signalrdquo from the background noise The action of the CMF identifies as the sum of the effects of superimposed continous and pulsed magnetic fields on biological systemsOn the bone tissue is possible to obtain a neo-osteomorphogenesis increasing the gene expression of the morphogenetic proteins

and modulating the osteoclastogenetic proteins action The same results we can obtain on soft tissue The target of our clinical trial ldquoin vivordquo can demonstrate the effects of Combined Magnetic Field on the bone tissue in oral implantology

Methods 458 patients of both genders aged between 35 and 72 yrs underwent implant surgery associated with GBR according to the protocol of the PBR implant system 1024

fixtures were inserted by means of the TMIreg implant system (Pressing Dental RSM) The MET and CMF (MFI Italy) were applied to all patients for 74 days

Osteogenesis was radiologically controlled after 30 60 90 and 120 days All implants were loaded in 120 days

86th General Session and Exibition of the IADR ndash Metro Toronto Convention Centre Canada

Osteomorphogenesis biostimulated by CMF Combined Magnetic Fields M Corigliano1 S Rossi2 F Crescentini2 A Giovanetti2 S Di Carlo2

1International Academy of Implantoprosthesis and Osteoconnection Rome Italy 2 University of Rome Sapienza Italy

Induttori della TME

applicati

CMF-OS amp BR (1) TME (2) MFI Production

1

2

Stimulated morphogenetic proteins gene expression

and modulation of osteoclastogenesis by CMF induction

FGF-2 FGFai AngiopoietinTrombopoietin EGFConnexin 43 Cox-1 e Cox-2 BMP-2 BMP-4 c-myc e c-fosG-proteinCollagen I osteocalcin

Signal Molecules Erk frac12CREBIRS-1eNOS Cytokine IL1 TNFαTNFβTGkαTGFβPDGFIGF-1IGF-

2FGF Osteoclastogenesis Modulators OPGRank RANKL

M-CSFPGE2 EnzymesCytocrome-OssidaseNaK-ATPase hsp70

ornithine decarboxilase adinylate-cyclase protein kinase C

Densification Proteins and ions Osteocalcin Procollagenionized calcium ALPEstrogen-receptor system

Proteoglycans Collagen IIITP1 TPIII

Results All those who underwent implant therapy with GBR and were treated with the combination of MET and CMF showed complete mineralization in a shorter period of time than that commonly reported in these

cases

Conclusions The combined use of MET and CMF together with the PBR implant system can ameliorate and strengthen the physiological mechanisms of bone reparation

Materials CMF-OS ampBR Inductor of CMF multifrequential and presequential with continous magnetic fields Frequency from 1 to 80Hz Amplitude from 1

a 100μT and field amplifierconcentrator TME inductor of bifrequential fieldAmplitude from 5 a 50G for domiciliary use

Induction Method 6 inductions with CMF every 3 days for 12 mindie and TME domiciliary 30min X 2die X 45 days( inductors MFI Italy)

1 2 3

Soft Tissues unsuccessfull gengivoplasty Fase1 date 11042007 (2)date 11182007 (3)12062007 CMF treated 6 X 12 min induction sequenced every 3days

Ludwig W Magneitc Field Therapy In Alternative Medicine Future Medicine Publishing Washington (1993) McLeod BR Liboff AR Dynamic characteristics of membrane ions in multifield configurations of low-frequency

electromagnetic radiationBioelectromagnetics 19867(2)177-89

Blank M Goodman R Electromagnetic fields may act directly on DNADepartment of Physiology Columbia University New York New York 10032 USA mb32columbiaedu J Cell Biochem 1999 Dec 175(3)369-74

Fig1 Dental-Scan Fig2 Implants Fig3 RX results After 45 days

CMF-TME therapy 1 2 3

Objectives The aim of this study was to obtain immediate bone reparation in only 6 wks and to predict primary bone apposition

without intermediate growth of the connective tissue

Methods We inserted 128 PBR (Primary Bone Reparation) implants (TMIreg Pressing Dental RSM) into 42 patients of both

genders aged between 29 and 68 yrs After 45 days 25 implants were removed from their sites carefully chosen so as not

to endanger either the final prosthesis plan or the patients health The removed samples were embedded in resin (Tecnovit

Kulzer) histologically prepared (EXAKT) and stained with hematoxylin eosin and methylene blue The same samples

were then examined histologically under an optical microscope (Zeiss and Leitz) at 50-100-200-400X

86th General Session and Exibition of the IADR ndash Metro Toronto Convention Centre Canada

Histologic evaluation of a PBR implant system study in manM CORIGLIANO1 S ROSSI2 AM CARPIO2 and S DI CARLO2

1International Academy of Implantoprosthesis and Osteoconnection Rome Italy 2University

of Rome Sapienza Italy

1 Schenk RK Histologie der Primarien Knocheilung Verh Dtsch ges pathol 1974 54 8-12

2 Corigliano M Vrespa G DrsquoAddona A Casolo F Impianto a guarigione primaria Dental Cadmos 1994 11 60-72

3 Piattelli A Paolantonio M Corigliano M Scarano A Immediate loading of titanium plasma-sprayed screw-shaped implants in man a clinical and histological report of two cases J Periodontol 199768591-

597

3 Corigliano M Barlattani A Gargari M Ottria L Andreana S La riparazione ossea primaria in implantoprotesi possibilitagrave tecnica ed applicazioni Quint Int 2002 910 359-370

4 Cooper LF Rahman A Moriarty J Chaffee N Sacco D Immediate mandibular rehabilitation with endosseous implants simultaneous extraction implant placement and loadingInt J Oral Maxillofac

Implants 200217(4)517-25

5 Gherlone E Albano F Vrespa G Falegatti G Capuano A Carico immediato su impianti post estrattivi immediati Implantologia 2004125-37

6 Forabosco A et al Impianti postestrattivi a carico immediato Doctor Os 200617(1)188-190

6

TMI reg Implant System is composed by

Fig1 Pilot Drill

Fig2 Osteotom ldquo UNICArdquo

Fig3 Implant

2

Results The quantity and the quality of the bone observed histologically

in connection with the radicular titanium prostheses following PBR

registered complete growth The BIC (Bone Implant Contact) measured

all around the removed implants averaged 85 Further there were no

necrotic zones associated with the resorption or substitution with

connective fibrous tissue

Conclusions Our histologic analysis demonstrates that the PBR

implant system is without doubt reliable Actually it permits a

great deal of bone to support the progressive load of dental

prostheses

2

Histological images coloured

with hematoxylineosin and

methilene blue

Surgycal phases

1 Drilling

2 Osteotomy with ldquoUNICArdquo

3 Radicular prostheses

insert

85th General Session amp Exhibition of the IADRNew Orleans 21-24 March 2007

EARLY LOADED IMPLANT SUPPORTED OVERDENTURE 3-YEAR FOLLOW-UP EVALUATIONS ROSSI I VOZZA A GIOVANNETTI MP BASILE S DI CARLO

Dental School Prosthodontics Department ldquoLa Sapienzardquo University Rome Italy

INTRODUCTION

Primary Bone Reparation PBR is a mechanism of natural bone healing determining consolidation of two bone segments in 6 weeks In Implantology PBR implantsconsent to patient having prosthetic rehabilitation briefly because it is possible to load them just in 45 days form fixture insertion This is possible thanking to firstintention bone healing with direct formation of bone tissue in contact with implant and without interposition of connective tissue Times of tissue reparationaround implants are superimposable to times of a simple fracture of maxilla The aim of this study was to evaluate perimplant marginal bone level on early loadedimplants supporting overdenture

REFERENCES

Attard NJ Zarb GA Immediate and early implant loading protocols a literature review of clinical studies J Prosthet Dent 200594(3)242-58

Brochu JF Anderson JD Zarb GA The influence of early loading on bony crest height and stability a pilot study Int J Prosthodont 200518(6)506-12

Chiapasco M Early and immediate restoration and loading of implants in completely edentulous patients Int J Oral Maxillofac Implants 200419 Suppl76-91

Mericske-Stern R Oetterli M Kiener P Mericske E A follow-up study of maxillary implants supporting an overdenture clinical and radiographic results Int J Oral Maxillofac Implants 200217(5)678-86

Misch CE Degidi M 5-year prospective study of immediateearly loading of fixed prostheses in completely edentulous jaw with a bone quality-based implant system Clin Implant Dent Relat Res 20035(1)17-28

Payne AG Tawse-Smith A Thomson WM Duncan WD Kumara R One-stage surgery and early loading of three implants for maxillary overdenture a 1-year report Clin Implant Dent Relat Res 20046(2)61-74

Raghoebar GM Friberg B Grunert I Hobkirk JA Tepper G Wendelhag I 3-year prospective multicenter study on one-stage implant surgery and early loading in the edentulous mandible Clin Implant Dent Relat Res 20035(1)39-46

Raghoebar GM Schoen P Meijer HJ Stellingsma K Vissink A Early loading of endosseous implants in the augmented maxilla a 1-year prospective study Clin Oral Implants Res 200314(6)697-702

MATERIALS AND METHODSIn our Prosthodontics Depratment La Sapienza University of Rome from May 2001 to December November 2003 we selected 30 patients (both sexes 49 yearsmean age no smokers) having maxillary total edentulism and asking for fixed prosthetic rehabilitation We inserted 128 root former implants (TMI PressingDental San Marino) they were early loaded after 45 days Minimum diameter was 42mm and minimum length was 13mm Before cementation of each finalrestoration we executed a periapical X-ray using a digital X-ray system (Den Optix Gendex Dentsply Int) The X-ray controls were executed after 1-3-6-9-12months and then yearly

RESULTSMarginal bone levels were evaluated by 2 different operators using a computerised measure system (Vix-win 2000 Gendex Dentsply Int) During the first yearthere was 028mm mean bone loss while during the next two years it was 017mm according to Albrektsson and Zarb implant success criteria (lt1mm during thefirst year and lt02mm during next years) X-ray results analized with T-Student test were statistically significant (Plt0005)

CONCLUSIONSParameters for the valuation of Implantology success have to be established before discussing about obtained results by this experimentation On the basis ofthis osseointegration definition clinical studies have to be purposed to survey the implant stability under functional loading In this order itrsquos necessary thatduring periodic controls implant mobility has to be evaluated and radiographic examinations have to be executed in a reproducible way for determining the stateof perimplant bone tissue health The implant success is evaluated on the following criteria by Albrektsson and Zarb 1) the not splinted implant has to be clinicallyimmovable 2) on the X-ray no perimplant radiotranslucency marks have to be present 3) vertical bone loss has to be lower than 1mm during the first year ofloading and lower than 02mm yearly in the following years 4) each implant has to be without marks or persistent andor not reversible symptoms for examplepain infections neuropathies paresthesis or penetration into the mandibular canal 5)prosthetic restoration has to satisfy function and aesthetics On thesepreliminary remarks in the anterior upper and lower sectors it should occur a success rate of 90 and 85 on long time respectively after 5 and 10 years in theposterior sectors these percentages have to be about 85 after 5 years and 80 after 10 years The obtained results from this experimentation are encouragingfully respecting implant success criteria by Albrektsson and Zarb These results showed as early loaded implants supporting overdenture are clinically andradiographically well osseointegrated

516

Introduction ndash It has been clearly proved by Ludwig through Fourierrsquos analysis [ Ludwig1993] that ultraweak signals are easly recognazed compared with the background noise if they present a patternthe signals the living matter is able to recognized among a variety of interferential signals are highly complex that is they are made up of different frequency bands Infact the complex signal reaches the biological system as a repetition of weak signals but connected among them in a fixed pattern and it is the

repetition of this pattern that distinguish the ldquotrue signalrdquo from the background noise The action of the CMF identifies as the sum of the effects of superimposed continous and pulsed magnetic fields on biological systemsOn the bone tissue is possible to obtain a neo-osteomorphogenesis increasing the gene expression of the morphogenetic proteins

and modulating the osteoclastogenetic proteins action The same results we can obtain on soft tissue The target of our clinical trial ldquoin vivordquo can demonstrate the effects of Combined Magnetic Field on the bone tissue in oral implantology

Methods 458 patients of both genders aged between 35 and 72 yrs underwent implant surgery associated with GBR according to the protocol of the PBR implant system 1024

fixtures were inserted by means of the TMIreg implant system (Pressing Dental RSM) The MET and CMF (MFI Italy) were applied to all patients for 74 days

Osteogenesis was radiologically controlled after 30 60 90 and 120 days All implants were loaded in 120 days

86th General Session and Exibition of the IADR ndash Metro Toronto Convention Centre Canada

Osteomorphogenesis biostimulated by CMF Combined Magnetic Fields M Corigliano1 S Rossi2 F Crescentini2 A Giovanetti2 S Di Carlo2

1International Academy of Implantoprosthesis and Osteoconnection Rome Italy 2 University of Rome Sapienza Italy

Induttori della TME

applicati

CMF-OS amp BR (1) TME (2) MFI Production

1

2

Stimulated morphogenetic proteins gene expression

and modulation of osteoclastogenesis by CMF induction

FGF-2 FGFai AngiopoietinTrombopoietin EGFConnexin 43 Cox-1 e Cox-2 BMP-2 BMP-4 c-myc e c-fosG-proteinCollagen I osteocalcin

Signal Molecules Erk frac12CREBIRS-1eNOS Cytokine IL1 TNFαTNFβTGkαTGFβPDGFIGF-1IGF-

2FGF Osteoclastogenesis Modulators OPGRank RANKL

M-CSFPGE2 EnzymesCytocrome-OssidaseNaK-ATPase hsp70

ornithine decarboxilase adinylate-cyclase protein kinase C

Densification Proteins and ions Osteocalcin Procollagenionized calcium ALPEstrogen-receptor system

Proteoglycans Collagen IIITP1 TPIII

Results All those who underwent implant therapy with GBR and were treated with the combination of MET and CMF showed complete mineralization in a shorter period of time than that commonly reported in these

cases

Conclusions The combined use of MET and CMF together with the PBR implant system can ameliorate and strengthen the physiological mechanisms of bone reparation

Materials CMF-OS ampBR Inductor of CMF multifrequential and presequential with continous magnetic fields Frequency from 1 to 80Hz Amplitude from 1

a 100μT and field amplifierconcentrator TME inductor of bifrequential fieldAmplitude from 5 a 50G for domiciliary use

Induction Method 6 inductions with CMF every 3 days for 12 mindie and TME domiciliary 30min X 2die X 45 days( inductors MFI Italy)

1 2 3

Soft Tissues unsuccessfull gengivoplasty Fase1 date 11042007 (2)date 11182007 (3)12062007 CMF treated 6 X 12 min induction sequenced every 3days

Ludwig W Magneitc Field Therapy In Alternative Medicine Future Medicine Publishing Washington (1993) McLeod BR Liboff AR Dynamic characteristics of membrane ions in multifield configurations of low-frequency

electromagnetic radiationBioelectromagnetics 19867(2)177-89

Blank M Goodman R Electromagnetic fields may act directly on DNADepartment of Physiology Columbia University New York New York 10032 USA mb32columbiaedu J Cell Biochem 1999 Dec 175(3)369-74

Fig1 Dental-Scan Fig2 Implants Fig3 RX results After 45 days

CMF-TME therapy 1 2 3

85th General Session amp Exhibition of the IADRNew Orleans 21-24 March 2007

EARLY LOADED IMPLANT SUPPORTED OVERDENTURE 3-YEAR FOLLOW-UP EVALUATIONS ROSSI I VOZZA A GIOVANNETTI MP BASILE S DI CARLO

Dental School Prosthodontics Department ldquoLa Sapienzardquo University Rome Italy

INTRODUCTION

Primary Bone Reparation PBR is a mechanism of natural bone healing determining consolidation of two bone segments in 6 weeks In Implantology PBR implantsconsent to patient having prosthetic rehabilitation briefly because it is possible to load them just in 45 days form fixture insertion This is possible thanking to firstintention bone healing with direct formation of bone tissue in contact with implant and without interposition of connective tissue Times of tissue reparationaround implants are superimposable to times of a simple fracture of maxilla The aim of this study was to evaluate perimplant marginal bone level on early loadedimplants supporting overdenture

REFERENCES

Attard NJ Zarb GA Immediate and early implant loading protocols a literature review of clinical studies J Prosthet Dent 200594(3)242-58

Brochu JF Anderson JD Zarb GA The influence of early loading on bony crest height and stability a pilot study Int J Prosthodont 200518(6)506-12

Chiapasco M Early and immediate restoration and loading of implants in completely edentulous patients Int J Oral Maxillofac Implants 200419 Suppl76-91

Mericske-Stern R Oetterli M Kiener P Mericske E A follow-up study of maxillary implants supporting an overdenture clinical and radiographic results Int J Oral Maxillofac Implants 200217(5)678-86

Misch CE Degidi M 5-year prospective study of immediateearly loading of fixed prostheses in completely edentulous jaw with a bone quality-based implant system Clin Implant Dent Relat Res 20035(1)17-28

Payne AG Tawse-Smith A Thomson WM Duncan WD Kumara R One-stage surgery and early loading of three implants for maxillary overdenture a 1-year report Clin Implant Dent Relat Res 20046(2)61-74

Raghoebar GM Friberg B Grunert I Hobkirk JA Tepper G Wendelhag I 3-year prospective multicenter study on one-stage implant surgery and early loading in the edentulous mandible Clin Implant Dent Relat Res 20035(1)39-46

Raghoebar GM Schoen P Meijer HJ Stellingsma K Vissink A Early loading of endosseous implants in the augmented maxilla a 1-year prospective study Clin Oral Implants Res 200314(6)697-702

MATERIALS AND METHODSIn our Prosthodontics Depratment La Sapienza University of Rome from May 2001 to December November 2003 we selected 30 patients (both sexes 49 yearsmean age no smokers) having maxillary total edentulism and asking for fixed prosthetic rehabilitation We inserted 128 root former implants (TMI PressingDental San Marino) they were early loaded after 45 days Minimum diameter was 42mm and minimum length was 13mm Before cementation of each finalrestoration we executed a periapical X-ray using a digital X-ray system (Den Optix Gendex Dentsply Int) The X-ray controls were executed after 1-3-6-9-12months and then yearly

RESULTSMarginal bone levels were evaluated by 2 different operators using a computerised measure system (Vix-win 2000 Gendex Dentsply Int) During the first yearthere was 028mm mean bone loss while during the next two years it was 017mm according to Albrektsson and Zarb implant success criteria (lt1mm during thefirst year and lt02mm during next years) X-ray results analized with T-Student test were statistically significant (Plt0005)

CONCLUSIONSParameters for the valuation of Implantology success have to be established before discussing about obtained results by this experimentation On the basis ofthis osseointegration definition clinical studies have to be purposed to survey the implant stability under functional loading In this order itrsquos necessary thatduring periodic controls implant mobility has to be evaluated and radiographic examinations have to be executed in a reproducible way for determining the stateof perimplant bone tissue health The implant success is evaluated on the following criteria by Albrektsson and Zarb 1) the not splinted implant has to be clinicallyimmovable 2) on the X-ray no perimplant radiotranslucency marks have to be present 3) vertical bone loss has to be lower than 1mm during the first year ofloading and lower than 02mm yearly in the following years 4) each implant has to be without marks or persistent andor not reversible symptoms for examplepain infections neuropathies paresthesis or penetration into the mandibular canal 5)prosthetic restoration has to satisfy function and aesthetics On thesepreliminary remarks in the anterior upper and lower sectors it should occur a success rate of 90 and 85 on long time respectively after 5 and 10 years in theposterior sectors these percentages have to be about 85 after 5 years and 80 after 10 years The obtained results from this experimentation are encouragingfully respecting implant success criteria by Albrektsson and Zarb These results showed as early loaded implants supporting overdenture are clinically andradiographically well osseointegrated

516

Introduction ndash It has been clearly proved by Ludwig through Fourierrsquos analysis [ Ludwig1993] that ultraweak signals are easly recognazed compared with the background noise if they present a patternthe signals the living matter is able to recognized among a variety of interferential signals are highly complex that is they are made up of different frequency bands Infact the complex signal reaches the biological system as a repetition of weak signals but connected among them in a fixed pattern and it is the

repetition of this pattern that distinguish the ldquotrue signalrdquo from the background noise The action of the CMF identifies as the sum of the effects of superimposed continous and pulsed magnetic fields on biological systemsOn the bone tissue is possible to obtain a neo-osteomorphogenesis increasing the gene expression of the morphogenetic proteins

and modulating the osteoclastogenetic proteins action The same results we can obtain on soft tissue The target of our clinical trial ldquoin vivordquo can demonstrate the effects of Combined Magnetic Field on the bone tissue in oral implantology

Methods 458 patients of both genders aged between 35 and 72 yrs underwent implant surgery associated with GBR according to the protocol of the PBR implant system 1024

fixtures were inserted by means of the TMIreg implant system (Pressing Dental RSM) The MET and CMF (MFI Italy) were applied to all patients for 74 days

Osteogenesis was radiologically controlled after 30 60 90 and 120 days All implants were loaded in 120 days

86th General Session and Exibition of the IADR ndash Metro Toronto Convention Centre Canada

Osteomorphogenesis biostimulated by CMF Combined Magnetic Fields M Corigliano1 S Rossi2 F Crescentini2 A Giovanetti2 S Di Carlo2

1International Academy of Implantoprosthesis and Osteoconnection Rome Italy 2 University of Rome Sapienza Italy

Induttori della TME

applicati

CMF-OS amp BR (1) TME (2) MFI Production

1

2

Stimulated morphogenetic proteins gene expression

and modulation of osteoclastogenesis by CMF induction

FGF-2 FGFai AngiopoietinTrombopoietin EGFConnexin 43 Cox-1 e Cox-2 BMP-2 BMP-4 c-myc e c-fosG-proteinCollagen I osteocalcin

Signal Molecules Erk frac12CREBIRS-1eNOS Cytokine IL1 TNFαTNFβTGkαTGFβPDGFIGF-1IGF-

2FGF Osteoclastogenesis Modulators OPGRank RANKL

M-CSFPGE2 EnzymesCytocrome-OssidaseNaK-ATPase hsp70

ornithine decarboxilase adinylate-cyclase protein kinase C

Densification Proteins and ions Osteocalcin Procollagenionized calcium ALPEstrogen-receptor system

Proteoglycans Collagen IIITP1 TPIII

Results All those who underwent implant therapy with GBR and were treated with the combination of MET and CMF showed complete mineralization in a shorter period of time than that commonly reported in these

cases

Conclusions The combined use of MET and CMF together with the PBR implant system can ameliorate and strengthen the physiological mechanisms of bone reparation

Materials CMF-OS ampBR Inductor of CMF multifrequential and presequential with continous magnetic fields Frequency from 1 to 80Hz Amplitude from 1

a 100μT and field amplifierconcentrator TME inductor of bifrequential fieldAmplitude from 5 a 50G for domiciliary use

Induction Method 6 inductions with CMF every 3 days for 12 mindie and TME domiciliary 30min X 2die X 45 days( inductors MFI Italy)

1 2 3

Soft Tissues unsuccessfull gengivoplasty Fase1 date 11042007 (2)date 11182007 (3)12062007 CMF treated 6 X 12 min induction sequenced every 3days

Ludwig W Magneitc Field Therapy In Alternative Medicine Future Medicine Publishing Washington (1993) McLeod BR Liboff AR Dynamic characteristics of membrane ions in multifield configurations of low-frequency

electromagnetic radiationBioelectromagnetics 19867(2)177-89

Blank M Goodman R Electromagnetic fields may act directly on DNADepartment of Physiology Columbia University New York New York 10032 USA mb32columbiaedu J Cell Biochem 1999 Dec 175(3)369-74

Fig1 Dental-Scan Fig2 Implants Fig3 RX results After 45 days

CMF-TME therapy 1 2 3

Introduction ndash It has been clearly proved by Ludwig through Fourierrsquos analysis [ Ludwig1993] that ultraweak signals are easly recognazed compared with the background noise if they present a patternthe signals the living matter is able to recognized among a variety of interferential signals are highly complex that is they are made up of different frequency bands Infact the complex signal reaches the biological system as a repetition of weak signals but connected among them in a fixed pattern and it is the

repetition of this pattern that distinguish the ldquotrue signalrdquo from the background noise The action of the CMF identifies as the sum of the effects of superimposed continous and pulsed magnetic fields on biological systemsOn the bone tissue is possible to obtain a neo-osteomorphogenesis increasing the gene expression of the morphogenetic proteins

and modulating the osteoclastogenetic proteins action The same results we can obtain on soft tissue The target of our clinical trial ldquoin vivordquo can demonstrate the effects of Combined Magnetic Field on the bone tissue in oral implantology

Methods 458 patients of both genders aged between 35 and 72 yrs underwent implant surgery associated with GBR according to the protocol of the PBR implant system 1024

fixtures were inserted by means of the TMIreg implant system (Pressing Dental RSM) The MET and CMF (MFI Italy) were applied to all patients for 74 days

Osteogenesis was radiologically controlled after 30 60 90 and 120 days All implants were loaded in 120 days

86th General Session and Exibition of the IADR ndash Metro Toronto Convention Centre Canada

Osteomorphogenesis biostimulated by CMF Combined Magnetic Fields M Corigliano1 S Rossi2 F Crescentini2 A Giovanetti2 S Di Carlo2

1International Academy of Implantoprosthesis and Osteoconnection Rome Italy 2 University of Rome Sapienza Italy

Induttori della TME

applicati

CMF-OS amp BR (1) TME (2) MFI Production

1

2

Stimulated morphogenetic proteins gene expression

and modulation of osteoclastogenesis by CMF induction

FGF-2 FGFai AngiopoietinTrombopoietin EGFConnexin 43 Cox-1 e Cox-2 BMP-2 BMP-4 c-myc e c-fosG-proteinCollagen I osteocalcin

Signal Molecules Erk frac12CREBIRS-1eNOS Cytokine IL1 TNFαTNFβTGkαTGFβPDGFIGF-1IGF-

2FGF Osteoclastogenesis Modulators OPGRank RANKL

M-CSFPGE2 EnzymesCytocrome-OssidaseNaK-ATPase hsp70

ornithine decarboxilase adinylate-cyclase protein kinase C

Densification Proteins and ions Osteocalcin Procollagenionized calcium ALPEstrogen-receptor system

Proteoglycans Collagen IIITP1 TPIII

Results All those who underwent implant therapy with GBR and were treated with the combination of MET and CMF showed complete mineralization in a shorter period of time than that commonly reported in these

cases

Conclusions The combined use of MET and CMF together with the PBR implant system can ameliorate and strengthen the physiological mechanisms of bone reparation

Materials CMF-OS ampBR Inductor of CMF multifrequential and presequential with continous magnetic fields Frequency from 1 to 80Hz Amplitude from 1

a 100μT and field amplifierconcentrator TME inductor of bifrequential fieldAmplitude from 5 a 50G for domiciliary use

Induction Method 6 inductions with CMF every 3 days for 12 mindie and TME domiciliary 30min X 2die X 45 days( inductors MFI Italy)

1 2 3

Soft Tissues unsuccessfull gengivoplasty Fase1 date 11042007 (2)date 11182007 (3)12062007 CMF treated 6 X 12 min induction sequenced every 3days

Ludwig W Magneitc Field Therapy In Alternative Medicine Future Medicine Publishing Washington (1993) McLeod BR Liboff AR Dynamic characteristics of membrane ions in multifield configurations of low-frequency

electromagnetic radiationBioelectromagnetics 19867(2)177-89

Blank M Goodman R Electromagnetic fields may act directly on DNADepartment of Physiology Columbia University New York New York 10032 USA mb32columbiaedu J Cell Biochem 1999 Dec 175(3)369-74

Fig1 Dental-Scan Fig2 Implants Fig3 RX results After 45 days

CMF-TME therapy 1 2 3

XV CONGRESSO NAZIONALE DEL COLLEGIO DEI DOCENTI

ROMA 16-19 APRILE 2008

Uso degli impianti TMI nella Riparazione Ossea Primaria nei post-estrattivi a carico immediato

S Rossi A Giovannetti M Corigliano S Di Carlo Universitagrave di Roma ldquoSapienzardquo Dipartimento di Scienze Odontostomatologiche

Insegnamento di Protesi Dentaria I Titolare Prof S Di Carlo

INTRODUZIONE

La terapia implanto-protesica ha rappresentato negli ultimi decenni uno dei maggiori progressi ottenuti in ambito odontostomatologico Lrsquoavvento dellrsquoosteointegrazione ha radicalmente modificato lrsquoapproccio alla terapia implantare portando allo sviluppo di protocolli chirurgici e protesici standardizzati La riduzione o lrsquoeliminazione dellrsquointervallo di tempo tra lrsquoinserimento della fixture e la sua protesizzazione ha rappresentato quindi uno dei principali temi di ricerca in campo implantologico

MATERIALI E METODI

Lo scopo di questo lavoro egrave dimostrare i vantaggi offerti dalla Riparazione Ossea Primaria (ROP) nellrsquoapplicazione di uno o piugrave elementi a supporto implantare con carico immediato secondo un meccanismo di guarigione ossea naturale per prima intenzione Per carico immediato si intende lrsquoapplicazione di carichi (o forze) agli impianti subito dopo il loro posizionamento

Diversi autori hanno parlato perograve di carico immediato anche quando lrsquoapplicazione di forze non egrave immediata ma avviene dopo 24 ore 72 ore o anche a distanza di una

settimana Tale protocollo egrave in grado di offrire il vantaggio di ridurre le procedure chirurgiche e i tempi di attesa per la riabilitazione protesica provvisoria senza la

necessitagrave di dover ricorrere a protesi rimovibili Grazie allrsquoapplicazione del restauro provvisorio lrsquoosso risulta uniformemente ma non eccessivamente caricato ed egrave noto

come il carico occlusale induca una microstimolazione capace di incrementare qualitativamente e quantitativamente il processo di osteogenesi La ROP egrave un

meccanismo di guarigione ossea per prima intenzione mediante il quale due segmenti ossei traumatizzati con frattura semplice si consolidano in un periodo fisiologico

di sei settimane per rimodellamento Haversiano e lrsquoapplicazione di osso primario direttamente sullrsquoimpianto senza passare attraverso le fasi osteoclastica-macrofagica

connettivale di mineralizzazione della trama connettivale cosigrave come previsto dai protocolli per lrsquoottenimento dellrsquoosteointegrazione Lrsquoosteointegrazione necessita di 90

giorni di tempo per lrsquoapplicazione di un carico funzionale corretto infatti i tessuti traumatizzati riparano e si organizzano per seconda intenzione con una sequenza di

sette fasi Lrsquoosteoconnesione egrave un processo di riparazione ossea per prima intenzione che si svolge in tre passaggi ed in 42 giorni Lrsquoimpianto a ROP TMIreg egrave

caratterizzato da un aspetto radiciforme sviluppato sul principio dellrsquoaccoppiamento conico tra impianto ed un sito ricevente di identica forma e dimensioni con un collo

cilindrico e liscio di 25 mm di altezza ed un corpo a conicitagrave progressiva dotato di spire automaschianti a passo fisso Il corpo implantare egrave attraversato da 6 canali

verticali i quali evitano la compressione dei liquidi biologici depositati allrsquointerno della cavitagrave consentendone il deflusso

RISULTATI

Il termine di ROP risulta del tutto giustificato in implantoprotesi odontoiatrica percheacute la riparazione ossea che avviene intorno agli impianti TMIreg presenta gli stessi quadri istologici con un netto miglioramento dei tempi di guarigione Garantisce lrsquoattivazione delle cellule ossee quiescenti non egrave preceduta da riassorbimento neacute da formazione di tessuto cartilagineo o connettivo egrave quindi ldquodirettardquo

CONCLUSIONI

Questa ricerca egrave iniziata nel gennaio 2006 sono stati inseriti 82 impianti 51 nel mascellare superiore e 31 nella mandibola con lunghezze comprese tra 13 e 15 mm e Oslash tra 37 a 47 mm Al termine di questa prima fase di sperimentazione tutti gli impianti hanno raggiunto una valida osteoconnessione risultando una percentuale di successo del 100 Va tuttavia sottolineato che ancora tutti gli impianti non sono stati finalizzati protesicamente Possiamo affermare che gli impianti a ROP TMIreg consentono di accorciare notevolmente i tempi di guarigione garantendo una piugrave rapida risoluzione del caso

BIBLIOGRAFIA

1 Schenk RK Histologie der Primarien Knocheilung Verh Dtsch ges pathol 1974 54 8-12

2 Corigliano M Vrespa G DrsquoAddona A Casolo F Impianto a guarigione primaria Dental Cadmos 1994 11 60-72

3 Piattelli A Paolantonio M Corigliano M Scarano A Immediate loading of titanium plasma-sprayed screw-shaped implants in man a clinical and histological report of two cases J Periodontol 199768591-597

3 Corigliano M Barlattani A Gargari M Ottria L Andreana S La riparazione ossea primaria in implantoprotesi possibilitagrave tecnica ed applicazioni Quint Int 2002 910 359-370

4 Cooper LF Rahman A Moriarty J Chaffee N Sacco D Immediate mandibular rehabilitation with endosseous implants simultaneous extraction implant placement and loadingInt J Oral Maxillofac Implants 200217(4)517-25

5 Gherlone E Albano F Vrespa G Falegatti G Capuano A Carico immediato su impianti post estrattivi immediati Implantologia 2004125-37

6 Forabosco A et al Impianti postestrattivi a carico immediato Doctor Os 200617(1)188-190

Objectives The aim of the present study is to evaluate the effects of TMIreg (Pressing Dental RSM) implants in comparison with the post-extraction protocol in the immediate load

Methods We selected 138 individuals 79 men (mean age 5833 yrs) and 59 women (mean age 438 yrs) Of these 50 were smokers and 32 had periodontal disease We extracted 140 teeth 54 superior laterals 33 superior canines 28 inferior centrals and 27 inferior laterals The positioned implants were 136 for singular extraction 2 for double extraction (of adjacent elements) and 2 for the extraction of non-adjacent elements Eighty-four implants were positioned in the upper jaw and 56 in the lower jaw (52 implants Oslash 37 46 implants Oslash 42 and 42 implants Oslash 47 length from 13 to 15 mm) All implants were temporarily loaded with non-functional crowns for 75 days

86th General Session and Exibition of the IADR ndash Metro Toronto Convention Centre Canada

The immediate load in a post - extractive implant S ROSSI1 M CORIGLIANO2 S DI CARLO1 and G POMPA1

1University of Rome Sapienza Italy 2International Academy of Implantoprosthesis and Osteoconnection Rome Italy

1 Schenk RK Histologie der Primarien Knocheilung Verh Dtsch ges pathol 1974 54 8-12

2 Corigliano M Vrespa G DrsquoAddona A Casolo F Impianto a guarigione primaria Dental Cadmos 1994 11 60-72

3 Piattelli A Paolantonio M Corigliano M Scarano A Immediate loading of titanium plasma-sprayed screw-shaped implants in man a clinical and histological report of two cases J Periodontol 199768591-

597

3 Corigliano M Barlattani A Gargari M Ottria L Andreana S La riparazione ossea primaria in implantoprotesi possibilitagrave tecnica ed applicazioni Quint Int 2002 910 359-370

4 Cooper LF Rahman A Moriarty J Chaffee N Sacco D Immediate mandibular rehabilitation with endosseous implants simultaneous extraction implant placement and loadingInt J Oral Maxillofac

Implants 200217(4)517-25

5 Gherlone E Albano F Vrespa G Falegatti G Capuano A Carico immediato su impianti post estrattivi immediati Implantologia 2004125-37

6 Forabosco A et al Impianti postestrattivi a carico immediato Doctor Os 200617(1)188-190

5 6

Fig1 Pilot Drill Fig2 Osteotom ldquo UNICArdquo

Fig3 Implant

4

2

7

Results The experimental period has lasted 24 months thus far without showing any failure Before cementation of each final restoration we took periapical x-rays using a digital x-ray system (Den Optix Gendex Dentsply Int)

Conclusions The clinical and radiographic results showed that the treatment is completely effective if the strict inclusion criteria are suitably applied

2

9

10 11

Fig4 Fractured Tooth

Fig5 Fitting of the implant

Fig6 Fitted implant

Fig7 Temporary abutment

Fig8 Prepared abutment

Fig9 Temporary crown

Fig10 Final abutment

Fig12 Ceramic crown

Objectives The aim of the present study is to evaluate the effects of TMIreg (Pressing Dental RSM) implants in comparison with the post-extraction protocol in the immediate load

Methods We selected 138 individuals 79 men (mean age 5833 yrs) and 59 women (mean age 438 yrs) Of these 50 were smokers and 32 had periodontal disease We extracted 140 teeth 54 superior laterals 33 superior canines 28 inferior centrals and 27 inferior laterals The positioned implants were 136 for singular extraction 2 for double extraction (of adjacent elements) and 2 for the extraction of non-adjacent elements Eighty-four implants were positioned in the upper jaw and 56 in the lower jaw (52 implants Oslash 37 46 implants Oslash 42 and 42 implants Oslash 47 length from 13 to 15 mm) All implants were temporarily loaded with non-functional crowns for 75 days

86th General Session and Exibition of the IADR ndash Metro Toronto Convention Centre Canada

The immediate load in a post - extractive implant S ROSSI1 M CORIGLIANO2 S DI CARLO1 and G POMPA1

1University of Rome Sapienza Italy 2International Academy of Implantoprosthesis and Osteoconnection Rome Italy

1 Schenk RK Histologie der Primarien Knocheilung Verh Dtsch ges pathol 1974 54 8-12

2 Corigliano M Vrespa G DrsquoAddona A Casolo F Impianto a guarigione primaria Dental Cadmos 1994 11 60-72

3 Piattelli A Paolantonio M Corigliano M Scarano A Immediate loading of titanium plasma-sprayed screw-shaped implants in man a clinical and histological report of two cases J Periodontol 199768591-

597

3 Corigliano M Barlattani A Gargari M Ottria L Andreana S La riparazione ossea primaria in implantoprotesi possibilitagrave tecnica ed applicazioni Quint Int 2002 910 359-370

4 Cooper LF Rahman A Moriarty J Chaffee N Sacco D Immediate mandibular rehabilitation with endosseous implants simultaneous extraction implant placement and loadingInt J Oral Maxillofac

Implants 200217(4)517-25

5 Gherlone E Albano F Vrespa G Falegatti G Capuano A Carico immediato su impianti post estrattivi immediati Implantologia 2004125-37

6 Forabosco A et al Impianti postestrattivi a carico immediato Doctor Os 200617(1)188-190

5 6

Fig1 Pilot Drill Fig2 Osteotom ldquo UNICArdquo

Fig3 Implant

4

2

7

Results The experimental period has lasted 24 months thus far without showing any failure Before cementation of each final restoration we took periapical x-rays using a digital x-ray system (Den Optix Gendex Dentsply Int)

Conclusions The clinical and radiographic results showed that the treatment is completely effective if the strict inclusion criteria are suitably applied

2

9

10 11

Fig4 Fractured Tooth

Fig5 Fitting of the implant

Fig6 Fitted implant

Fig7 Temporary abutment

Fig8 Prepared abutment

Fig9 Temporary crown

Fig10 Final abutment

Fig12 Ceramic crown